Effective Nov. 1, 2016, Express Scripts will be the pharmacy benefit manager (PBM) for Amerigroup STAR Kids members in Texas.

 *Please see attached PDF for more information.

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."

Beginning today, Dec. 27, 2016, Amerigroup will change its “Refills Allowed After” (i.e. Refill Too Soon) limits for members enrolled in its Medicaid and CHIP plans.

The changes to the Medicaid Refills Allowed After limits will require members to use 90% of a prescription before a refill can be obtained. Claims submitted before the 90% threshold has been reached will reject with NCPDP Reject 79, “Refill Too Soon.”

*Please see attached PDF for more information.

Inside this issue of Express Scripts' Network Pharmacy Weekly you will find the following:

• Amerigroup/Anthem Formulary Updates
• Provider Manual Updates

*Please see attached PDF for more information.