Dear Valued Provider,

On October 26th, 2016, generic Benicar and Benicar HCT (olmesartan and olmesartan/ HCTZ) will become available to the market. Olmesartan and olmesartan/HCTZ will require a Prior Authorization by Florida Blue until multiple manufacturers become available or the price decreases. The innovator product Benicar/HCT will continue to be covered*.

Action Required

If Participating Pharmacies receive a prescription for olmesartan or olmesartan/HCTZ, they will need to submit brand name Benicar/HCT in order to receive a paid claim. If a prescription for olmesartan or olmesartan/HCTZ is submitted instead of brand name Benicar/HCT, the claim will reject at point-of-sale (POS) with the following reject message:

• NCPDP Reject Code 75: Prior Authorization
• Secondary Message: "Brand Benicar/HCT preferred, generic requires PA"

For questions regarding coverage of Benicar/HCT or the new product, please refer Covered Persons to the Customer Service number on the back of their Florida Blue ID card.

If you have any questions regarding claims processing, please call the Prime Contact Center at 800.821.4795.

Sincerely,

Pharmacy Network Management

Prime Therapeutics LLC