Effective January 1, 2017, CVS Caremark® will begin to administer the prescription benefits for Covanta. 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.

BIN: 011552 PCN: BCTX

Dear Valued Provider,

Participating Pharmacies may be experiencing claim rejections when trying to process claims for Covered Persons of Blue Cross and Blue Shield of Texas (BCBSTX).

Action Required:

Eligibility for these Covered Persons is currently being updated and expected to be corrected this evening. If you have a Covered Person with an urgent claim to be processed, please advise the Covered Person to call the Customer Service number on the back of their ID card.

Please communicate this information to your pharmacies to prevent further disruption of service for these Covered Persons.

Sincerely,

Pharmacy Network Management

Prime Therapeutics LLC

Please be alerted that beginning on November 4, 2016, at 11:00 p.m. CST until 11:45 p.m. CST on November 4th OptumRx Administrative Services, LLC, will experience a Point of Sale Claims Processing Outage on a portion of our business. The outage is due to an OptumRx scheduled system enhancement. Please reprocess claims after 11:45 pm CST on November 4, 2016.

Due to this maintenance we would like to remind you that there may be a delay in the posting of your 835 files by 1-2 business days for the affected pay cycle.

OptumRx apologizes for any inconvenience this may cause. OptumRx strives to prevent system processing outages. Your assistance in servicing patients and resubmitting claims is greatly appreciated.

Amendment to Performance Network Program Retail Network Enrollment FormsEffective January 1, 2017

To the extent the Provider is enrolled in the following networks, CVS Caremark® is amending the following Performance Network Program Network Enrollment Forms to reflect the amendments indicated below, effective January 1, 2017:

• Medicare Part D Retail Network 24–Performance Network Program
• Medicare Part D Retail Network 36–Performance Network Program
• Medicare Part D Retail Network 37–Performance Network Program–Preferred
• Medicare Part D Retail and Extended Days Supply Network 38–Performance Network Program
• Medicare Part D Retail and Extended Days Supply Network 39–Performance Network Program–Preferred

*Please see attached PDF for more information.

Effective December 1, 2016 you will be required to review the flagged medications and resolve any duplication in the system when the pharmacy system alerts you to duplicate medications using reason code TD (Therapeutic Duplication) for Florida UnitedHealthcare Community Plan members.

Code TD is a safety edit that compares the member’s current medications to the drug you are processing. It flags any patient request to fill a medication within a class of medication already filled within the last 30 days. The flag requires you to research why the patient is attempting to fill another medication in the same class so quickly. This TD safety edit previously went live with the Antipsychotic and Respiratory Drug classes and now includes the Diabetes and Opioid drug classes.

When a medication is flagged for TD, it produces a soft reject and displays this message:

TD: ANOTHER [specific drug class] PRODUCT WAS FILLED

*Please see attached PDF for more information.