Express Scripts is updating the process for submitting Florida Informed Consent Medicaid claims effective January 1, 2017. Pharmacies will need to submit Clarification Code 11 "Certification on File" in order for these claims to process. Please note impacted claims will have the secondary message "UNDER 13, RESUBMIT SCC 11, CERT ON FILE" as a reminder.

Currently pharmacies need to enter Prior Authorization (PA) type code 2 to identify they have the Florida Informed Consent on file and override reject 60 "Product/Service Not Covered for Patient Age."

Claims for members under the age of 13 filling for antipsychotic drugs will continue to reject with NCPDP reject code of 60 "Product/Service Not Covered For Patient Age ."

Please note that with Florida Informed Consent on file claims may still reject with NCPDP reject 75 "Prior Authorization required" or MR "Product not on Formulary", with a secondary message of "Non Pref Drug Contact Prescriber for chg to Preferred Drugs; or obtain a PA. Give Medicaid Pamphlet if not corrected." If this occurs please enter an override for an emergency fill, with PA code type 1 and PA type 1111.

If you have further questions, please contact the Express Scripts Pharmacy Help Desk at 800.922.1557.