Effective January 2017, CMS will require Medicare plan sponsors to implement a soft point of sale (POS) reject when an opioid prescription is presented following the initiation of buprenorphine for the treatment of opioid use disorder. An enhancement to the Drug-Drug Interaction (DDI) cDUR edit will be turned on to reject opioid claims when a member has a recent history of treatment with buprenorphine or buprenorphine containing products indicated for opioid dependence. If an opioid claim is submitted following an applicable buprenorphine claim at point of sale (POS), the claim will soft reject 88 with the following message: 

In October, two new reject codes will be released. Non-Medicare/Medicaid products will require the following updates to avoid Point-of-Sale Rejections:

• NCPDP Reject 39 (MISSING/INVALID DIAGNOSIS CODE)
• NCPDP REJECT CODE 614 (UPPER CASE REQUIRED)

*Please see attached PDF for more information.

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.

FORMULARY CHANGE

CIGNA COMMERCIAL CUSTOMERS

Cigna is making a formulary change to Samsca that may impact customers at your pharmacy. Effective 12/15/2016, Samsca will be covered as a specialty medication on Cigna's Prescription Drug List for non-Medicare/Medicaid members. Also, Samsca will be considered a "Limited Distribution Drug," meaning the manufacturer has chosen to limit its supply to only a few pharmacies in the United States.

*Please see attached PDF for more information.

As of June 26, 2015, claims for Multi-Ingredient Compounds (MICs) will process according to the Cigna-HealthSpring Medicare Part D Formularies.