CAPS would like to remind our member pharmacies of CVS/Caremark’s Manufacturer Coupon/Program Policy.

Precluded Prescriber

In accordance with CMS Final Rule CMS-4182-F, CVS Caremark will begin rejecting any claims prescribed be an individual on the Preclusion List effective April 1, 2019.  Claims will reject with the following or similar:

Appropriate Billing of Medications

•Purpose of communication: The CVS Caremark® Pharmacy Performance Department is providing network pharmacies with basic information on the appropriate billing of Bowel Prep Solutions to help prevent audit discrepancies and non-compliance with the CVS Caremark Provider Manual and Centers for Medicare and Medicaid Services (CMS) requirements.

In the "Claims Submission" of the Provider Manual, the last bullet of the "Additional information concerning all compounded medications" sub-section (beginning on page 22), is deleted in its entirety and replaced with the following:

The CVS Caremark Pharmacy Performance Department is providing network pharmacies with a reminder regarding your contractual requirements with respect to collection of Patient Pay Amounts and maintaining documentation of proof of payment.