APNS has received numerous inquiries regarding drastic reductions in Cigna HealthSpring reimbursement.  We have notified OptumRx of this issue and will post any updates or information we receive.

Dear Pharmacy Provider,

Please find attached the 2016-2017 MagellanRx Pharmacy Network Fee Schedule VAC-16 which updates the current reimbursement for vaccines covered under our Commercial and Medicaid lines of business that elect to cover vaccines along with Medicare Part D:

• VAC-16 replaces Pharmacy Network Fee Schedule VAC-15 and will be utilized for Medicare Part D and Commercial and Medicaid plans where vaccines are covered under the pharmacy benefit for the 2016-2017 flu season.

Effective 1/1/2017, Cigna will be making formulary changes that may impact customers at your pharmacy. Cigna will limit the number of preferred drugs in certain drug classes within our formularies. Some drug classes will feature one or a select set of preferred brand name drugs, and other brand name equivalent drugs will only be covered by going through Cigna’s medical necessity review process. We have included a list of drugs – by drug class – that will be considered non-covered or non-preferred brand as of 1/1/17 and their covered alternatives. We sent letters to the customers and prescribers explaining the impact, based on their current medications.

*Please see attached PDF for more information.