To ensure the safe use of opioid pain medications, all CareSource Medicaid opioid pharmacy claims will be subject to utilization management (UM) strategies. One such UM strategy is a morphine equivalent dose (MED) DUR edit.

The new Benefit Stage Qualifier (BSQ) 51 will be implemented on Jan 1, 2018 to assist in identifying Qualified Medicare Beneficiaries (QMB) at the point of sale.

Effective January 1, 2018, Prime Therapeutics (Prime) will begin processing Medicare Part D and Part B claims for Covered Persons of Blue Cross Blue Shield of Texas (BCBSTX) Blue Cross Medicare Advantage Select (HMO) and Value (HMO).

First-Time Opioid users o TennCare defines a first-time user as a member who has not filled opioid prescriptions in the preceding 180 day period

In accordance with Kentucky MAC law (Ky.Rev.Stat.Ann. §304.17A-162), the following is a list of products for which CVS Caremark® MAC adjustments have been made with retroactive effective dates as a result of granted MAC appeals.