Express Scripts is updating the process for submitting Florida Informed Consent Medicaid claims effective January 1, 2017. Pharmacies will need to submit Clarification Code 11 "Certification on File" in order for these claims to process. Please note impacted claims will have the secondary message "UNDER 13, RESUBMIT SCC 11, CERT ON FILE" as a reminder.

Currently pharmacies need to enter Prior Authorization (PA) type code 2 to identify they have the Florida Informed Consent on file and override reject 60 "Product/Service Not Covered for Patient Age."

This document outlines which Aetna retail pharmacy network is associated with each 2017 Aetna/Coventry MAPD and PDP plan.

Aetna will use the same Medicare retail pharmacy networks in 2017 as in 2016.

• P1: A broad network with both preferred and standard cost‐sharing components.
• S2: A broad network without a preferred cost‐sharing component.

*Please see attached PDF for more information.

Aetna is committed to helping members achieve and maintain their best health. We appreciate the role you play in helping Medicare beneficiaries get the medicines they need at affordable prices. We want to address concerns expressed about Aetna (and Coventry) Medicare drug pricing for next year. You may see a price decrease at point of sale for certain medications. This is because of two factors:  We worked with your Pharmacy Services Administrative Organization (PSAO) to get the best possible prices for our members.  Starting January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) require that all price concessions, that can be reasonably determined at point of sale, are taken at the point of sale rather than during post-sale adjudication.

Dear independent pharmacy leader,

NCPA had a call with CMS this week and was able to find out the following information about upcoming changes in the Aetna / Coventry Part D plans: