Appropriate Billing of Medications

•Purpose of communication: The CVS Caremark® Pharmacy Performance Department is providing network pharmacies with basic information on the appropriate billing of Bowel Prep Solutions to help prevent audit discrepancies and non-compliance with the CVS Caremark Provider Manual and Centers for Medicare and Medicaid Services (CMS) requirements.

The OptumRx Provider Portal enables our contracted pharmacies to access tools and resources to help serve patients as well as manage their businesses. This is a one-stop source for providers and pharmacies who write and fill prescriptions.

Caremark has previously notified Providers that Pharmaceutical Manufacturer Coupons from Affordable Medication Solutions or RetainRx were specifically disallowed to be utilized to reduce Eligible Person Patient Pay Amounts and their use would be deemed to be a non-allowed waiver of copayment (see May 18, 2017 Communication below). Coupons from Phoenix PBM and all associated programs including, but not limited to, The Association for Precision Pharmacy Services and Arena Health Foundation are not allowed to be used on Claims submitted to CVS Caremark.