Caremark has previously notified Providers that Pharmaceutical Manufacturer Coupons from Affordable Medication Solutions or RetainRx were specifically disallowed to be utilized to reduce Eligible Person Patient Pay Amounts and their use would be deemed to be a non-allowed waiver of copayment (see May 18, 2017 Communication below). Coupons from Phoenix PBM and all associated programs including, but not limited to, The Association for Precision Pharmacy Services and Arena Health Foundation are not allowed to be used on Claims submitted to CVS Caremark.

As stated in the CVS Caremark Provider Manual, Providers must provide to Part D Enrollees a written copy of the standardized pharmacy notice when a Part D Enrollee’s prescription cannot be filled under the Medicare Part D benefit at the point of sale. 42 C.F.R. §§ 423.128(b)(7)(iii) and 423.562(a)(3).

In the "Medicare Part D" section (beginning on page 57), the Information on CMS-10147 Pharmacy Notice subsection is deleted in its entirety and replaced with the following:

Background As previously communicated on November 25, 2015, effective January 1, 2016, proration of a member’s daily cost share (copayment) in order to support the synchronization of prescription fills is being implemented by select fully-insured commercial and some State Medicaid and Marketplace Plan Sponsors. When implemented by a Plan Sponsor, this functionality will apply a daily cost-sharing rate to a prescription presented to a network pharmacy that is dispensed for less than the plan-defined one-month supply. IMPORTANT FOR PROVIDERS IN OHIO: Per OH Gen Assembly Sub. H.B. No.116, Section 1751.68 [Effective 8/31/2016], Provisions for medication synchronization for enrollees: An agreement that provides for medication synchronization by adhering to all of the stated conditions shall permit and apply a prorated daily cost-sharing rate for a supply of a prescription drug subject to medication synchronization that is dispensed at a network pharmacy.

Effective September 1, 2016, CVS Caremark® will begin to administer the prescription benefits for Venezia Transport. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark. RXBIN: 004336 RXPCN: ADV RXGRP: RX0317 Member ID Format: 9 digits, alpha only Person Code : 2 digits, required