About APCI

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Since 1984, APCI has been the ‘united voice of independent pharmacy’

APCI began as a small buying group for a limited number of independent pharmacies in central Alabama. Since that time, the cooperative has grown to more than 1,800 members pharmacies in 26 states, and provides its members with a wide range of products and services.

Our mission is to represent the economic and professional interests of independent pharmacies by providing leadership, vision, and a collective voice for our members in the healthcare marketplace. Our goal is to level the playing field for our member pharmacies by providing innovative, targeted programs to benefit our entire membership.

2

Jan

2017

OptumRx: Health Alliance Connect - Four Script Limit Prior Authorizations

Effective January 1st 2017

Effective 1/1/2017, Health Alliance Connect (Managed Medicaid) members will transition to traditional Medicaid. Health Alliance has not had a four prescription limit in place for Health Alliance Connect members. However, members who transition to traditional Medicaid will have the four prescription limit implemented. HFS wants pharmacies to be aware that they can initiate prior authorization for former Health Alliance Connect members who reach the four prescription limit. Please inform HFS that the patient is a former Health Alliance Connect member to help expedite these requests.

Please note, Health Alliance Medical Plans will continue to provide pharmacy coverage for a number of other plans through 2017 and beyond.

2

Jan

2017

CVS Caremark® Part D Services: 2017 Medicare Part D Marketing Guidance

The Marketing Guidance on pharmacy/provider marketing activities applies to contracted pharmacies. This includes pharmacies which have entered into co-branding relationships with Plan Sponsors.

Providers must not steer, or attempt to steer, potential Part D Enrollees toward a specific plan or limited number of plans. Providers may assist a Part D Enrollee in an objective assessment of his/her needs and potential options to meet those needs. However, any assistance provided to a Part D Enrollee by a contractual, co-branded, or otherwise affiliated Provider, must result in a plan selection that is always in the best interest of the Part D Enrollee. Providers may engage in discussions with Part D Enrollees should a Part D Enrollee seek advice. However, Providers must remain neutral when assisting a Part D Enrollee with enrollment decisions.

*Please see attached PDF for more information.

2

Jan

2017

CVS Caremark®: Envolve Pharmacy Solutions - Ambetter Network Transition

Effective January 1st 2017

Effective January 1, 2017 - Pharmacy claims processing for Ambetter Insured by Celtic will transition from Envolve Pharmacy Solutions (formerly US Script) to CVS/caremark.

All claims Ambetter Insured by Celtic will now be reimbursed according to your CVS/caremark Network Enrollment Forms and will be paid according to CVS/caremark processing rules and payment cycles, which will appear on your CVS/caremark 835 or remittance advice.

*Please see attached PDF for more information.

2

Jan

2017

CVS Caremark®: Florida Medicaid - Additional Weekly Disbursement

Effective January 2017

Effective this month, an additional weekly disbursement will be issued for Florida Medicaid claims, in order to comply with state Medicaid prompt pay requirements. You may receive multiple payments in a given week if applicable to your pharmacy.

Note: Pharmacy network participation varies by plan. Your pharmacy may not participate in all plans.

2

Jan

2017

PerformRx: Prestige Health Plan - E-Remit

Dear Pharmacy Provider,

Recently there has been an influx of concerns raised about receiving remittance advice with your funding checks administered by Argus. Please see the following communication from Argus on how to register with their E-Remit Program in order to obtain your remittance advice.

For any questions or issues with accessing Argus’ E-Remit Program please call Argus’ Reconciliation at 1-866-211-9459.

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