Texas now covers mosquito repellents for the prevention of Zika virus. The following notice describes claims processing, eligibility, and benefit information specific to the mosquito repellent benefit for the below programs. The last page of this document contains a prescription template for claims processing.

Covered programs*:

• Medicaid (Managed Care, MCO; and fee-for-service, FFS)
• Children's Health Insurance Program (CHIP) and CHIP-Perinate
• Children with Special Health Care Needs Services (CSHCN)
• Healthy Texas Women (HTW)

*Mosquito repellent is not a benefit of Kidney HealthCare

*Please see attached PDF for more information.

RXBIN: 004336

RXPCN: ADV

RXGRP: RX0418

Member ID Format: 11 digits, alphanumeric

Person Code: 2 digits, required

*Please see attached PDF for more information.

The vaccines listed within the reimbursement schedule include this season’s flu vaccine and others, as determined by the Centers for Disease Control and Prevention (CDC). EnvisionRx has identified pricing increases as well as new drugs added per the CDC website. The 2016-2017 Retail Vaccine Reimbursement Schedule attached has been updated to reflect these modifications.

Each vaccine is associated with a GPI. You may administer any NDC associated with these GPIs and your reimbursement will be the amount seen in the "Total Reimbursement per Dose" column (Drug cost + Administration Reimbursement). The Addendum and corresponding reimbursement schedule was effective on September 12th, 2016.

As a reminder, in order for your Pharmacy to be reimbursed correctly, please submit claims as you would normally with the NDC code. You must enter "Dose (ml)" from your Attachment A-Reimbursement in the "Metric Decimal or Quantity Dispensed" field which appears as FIELD # 442-E7 on your Payer Sheet.

You must submit "MA" in the "Pro Svc Code, Professional Service Code" field which appears as FIELD # 440-E5 on your Payer Sheet. The administration fee of $15.00 must go in the "Incent Amt Sub, Incentive Amount Submitted" field which appears as FIELD # 438-E3 on your Payer Sheet.

For questions about our retail vaccine network, you may reach me via email at ProvRelContracting@envisionrx.com. Please include "Vaccine Program" in the subject line.

*Please see attached PDF for more information.

RXBIN: 004336

RXPCN: ADV

RXGRP: RX0470

Member ID Format: 9 digits, numeric only

Person Code: not required

*Please see attached PDF for more information.