Express Scripts administers the prescription drug benefit for Consolidated Nuclear Security LLC members. Some of these members are changing benefit groups on March 1, 2016 and will receive new ID cards with their new Rx Group. (Please note the member ID number is not changing.) However, these members may not have their new cards by the March 1 effective date. If a Nuclear Security LLC claim rejects with NCPDP Reject Code 51 (Non-Matched Group ID), please ask the member for his/her new ID card or contact the Express Scripts Pharmacy Services Help Desk at 800.922.1557.

This communiqué is being sent to prescribers and pharmacies who are TennCare’s most frequent providers of compounded prescriptions. As a result of the State of Tennessee’s Legislature adoption of budget reductions this coming fiscal year, TennCare will be managing prescription compounds by requiring prior authorization to ensure medical necessity, and by implementing a level of effort compound fee structure.

Effective July 24, 2015, the following agents will be moved to non-preferred status on the TennCare PDL and be removed from the list of branded agents classified as generics meaning that they will now count as a brand toward members’ monthly prescription limits and copays.

Effective January 1, 2015, Magellan Medicaid Administration, Inc., d/b/a Magellan Health Services, will assume administrative operation of the Pharmacy Benefit Management (PBM) program for Tennessee CoverRx from the current administrating company, Express Scripts. At that same time, pharmacies will submit claims for payment through the new PBM system. The new system will provide point-of-sale (POS) claims processing.

Effective January 1, 2015, Magellan Medicaid Administration, Inc., d/b/a Magellan Health Services, will assume administrative operation of the Pharmacy Benefit Management (PBM) program for Tennessee CoverRx from the current administrating company, Express Scripts. At that same time, pharmacies will submit claims for payment through the new PBM system. The new system will provide point-of-sale (POS) claims processing.