Dear Network Pharmacy Partner,

Please be advised that, effective 06/01/2018, Harvard Pilgrim will go live with POS functionality to support Opioid Cumulative Dosing Program (OCDP). The program will:

•         Trigger a soft-stop rejection upon exceeding an initial cumulative MED threshold.  This soft reject may be overridden by submission of PPS codes, or alternatively via a coverage determination process, if necessary.

•         Trigger a hard-stop rejection upon exceeding a subsequent, higher cumulative MED threshold.  This hard reject can only be overridden via a coverage determination process.

•         Special Notation:  Please be advised MedImpact’s Call Center Representatives will not be able to enter and/or provide the PPS codes on the pharmacies behalf.  If the pharmacy cannot enter a PPS code, the claim will deny and follow the standard coverage determination process.  You may need to contact your software vendor to assist in entering the codes into your specific system. 

For more detailed information please see the attached communication.