Dear Pharmacy,

In an effort to support continued access to affordable prescription drug benefits, MedImpact Healthcare Systems, Inc., on behalf of participating plans, will preferentially cover the brand version of BENICAR, BENICAR HCT, AZOR and TRIBENZOR over their generics (OLMESARTAN, OLMESARTAN/HYDROCHLOROTHIAZIDE, AMLODIPINE/OLMESARTAN and OLMESARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE) when the generic becomes available in the market. Under this initiative, we will request pharmacies to dispense brand name BENICAR, BENICAR HCT, AZOR and TRIBENZOR and for all new and refill OLMESARTAN, OLMESARTAN/HYDROCHLOROTHIAZIDE, AMLODIPINE/OLMESARTAN and OLMESARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE prescriptions from 10/25/16 to approximately 04/2017 for members of participating plans. Pharmacies will continue to receive brand reimbursement for these fills.

To enable the pharmacist to determine which members are in a participating plan, the NDCs for the generic (OLMESARTAN, OLMESARTAN/HYDROCHLOROTHIAZIDE, AMLODIPINE/OLMESARTAN and OLMESARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE) will be blocked from adjudicating on claims for those members. The claim rejection response will contain a message reminding the pharmacist that they should dispense brand BENICAR, BENICAR HCT, AZOR and TRIBENZOR to the member.

If pharmacies need a DAW code to bypass internal edits, DAW code value 9 can be used:

• For D.0 claim submissions, DAW 9 means Substitution Allowed By Prescriber but Plan Requests Brand - Patient's Plan Requested Brand Product to Be Dispensed.
• If pharmacy is still submitting 5.1 claims, the use of DAW 9 – Other is recommended.

MedImpact clients, their members, and prescribers have been notified of this change.

If you have any questions concerning this letter, please contact a MedImpact representative at 1-888-648-6769.

Sincerely,

MedImpact Healthcare Systems, Inc.