Dear Pharmacy Provider,

Our records show that your pharmacy may have filled a prescription for Vivitrol for a MDwise member within the last 6 months. As of April 1, 2018, MDwise members will be required to fill Vivitrol prescriptions at a network specialty pharmacy.

Please direct MDwise members with Vivitrol prescriptions to one of the following network specialty pharmacies:

• AllianceRx Walgreens Prime (phone 1-866-656-8629; fax 317-587-7410)

• IU Health Retail Pharmacies

• Eskenazi Retail Pharmacies

If you have any questions, please call MDwise Customer Service at 1-800-356-1204.

BIN: 003585 PCN: ASPROD1 Group: MDW

Sincerely,

MDwise Pharmacy Department