The Center for Medicare & Medicaid Services (CMS) 

OptumRx Medicare Plans

Effective January 1, 2017, CMS will require Medicare plan sponsors to limit the daily cumulative dose of opioid products a member may obtain at Point of Sale (POS). The daily limit is referred to as the Morphine Equivalent Dose (MED) limit. The cumulative limit is based on a combination of drug strength and a product’s Morphine Milligram Equivalency (MME). The cumulative total daily MED value will be calculated based on the number of opioid drugs prescribed over a period of time which includes incoming claims and active claims history. Depending on the plan, there may be multiple MED limits with varying response levels (Soft or Hard reject). 

Effective January 1, 2017, CVS Caremark® will begin to administer the prescription benefits for IU Health Plans. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark.

*Please see attached PDF for more information.

 Charter Communications members have new ID cards that feature a new member ID number that took effect Jan. 1, 2017. Please ask members to present their new ID cards.

*Please see the attached PDF for more information.

Effective January 1, 2017, McLaren Advantage Diamond Plus claims will be processed through Argus Health Systems.

*Please see the attached PDF for more information.