• This issue of CAPS Newsletter discusses the following topics:

  
  

  • X-DEA Prescription Requirements
  • Prescriptions Written by a Nurse Practitioner (NP) or Physician Assistant (PA)
  • Insulin Part B vs. Part D Billing
  • Issuance of Multiple Schedule II Prescriptions
  • Biennial Controlled Substance Inventory Count
  • “Use as Directed”, “As Directed”, “Per Sliding Scale” Directions
  • Multiple Physicians Listed on a Prescription
  • Humana Audit $5 Penalty Fee
  • OIG/SAM Monthly Exclusion Checks 
  • Meet your CAPS Team

The purpose of this notice to TennCare pharmacy providers is to clarify the intent of the coverage of up to a 91-day supply of insulin products.

Effective October 1, 2016, Harvard Pilgrim’s preferred insulin products will be Lilly brand products, including all forms of Humulin and Humalog.  Harvard Pilgrim will require prior authorization for Novo Nordisk brand products.

Prior authorizations will be processed by MedImpact.

If you have any questions, please feel free to contact our Pharmacy Help Desk at 800-788-2949.

Members that have a question regarding their benefit should contact the Harvard Pilgrim Member Services Department using the phone number located on the back of their ID card

Harvard Pilgrim Health Care

BIN: 003585

PCN: 35000  

Health Plans, Inc.

BIN: 003585

PCN: 35026

Effective January 1, 2015, Novolin, Novolog, Lantus and Levemir will be the insulin products with preferred status for Commercial and Exchange Market formularies.