If Participating Pharmacies receive a prescription for quetiapine XR tablets, they will need to submit brand name Seroquel XR in order to receive a paid claim. If a prescription for quetiapine XR tablets is submitted instead of brand name Seroquel XR, the claim will reject at point-of-sale (POS) with the following reject message:

• NCPDP Reject Code 70: "Prod/Service Not Covered"

• Secondary Message: quetiapine XR tablets not covered, use Seroquel XR

For State of Alabama members only – brand Seroquel XR will continue to process with a tier 2 copay.

For Auburn University members only – brand Seroquel XR will process with a tier 2 copay.

For questions regarding coverage of Seroquel XR or the new product, please refer Covered Persons to the Customer Service number on the back of their Blue Cross ID card.

If you have any questions regarding claims processing, please call the Prime Contact Center at 800.821.4795.

Sincerely,

Pharmacy Network Management

Prime Therapeutics LLC

* Coverage of Seroquel XR is dependent on the Covered Person’s benefit plan

If Participating Pharmacies receive a prescription for quetiapine fumarate extended-release tablets, they will need to submit brand name Seroquel XR in order to receive a paid claim. If a prescription for quetiapine fumarate extended-release tablets is submitted instead of brand name Seroquel XR, the claim will reject at point-of-sale (POS) with the following reject message:

• NCPDP Reject Code 75: Prior Authorization

• Secondary Message: "Brand Seroquel XR preferred, generic requires PA"

For questions regarding coverage of Seroquel XR or the new product, please refer Covered Persons to the Customer Service number on the back of their Florida Blue ID card.

If you have any questions regarding claims processing, please call the Prime Contact Center at 800.821.4795.

Sincerely,

Pharmacy Network Management

Prime Therapeutics LLC

*Coverage of Seroquel XR is dependent on the Covered Person's benefit plan

If Participating Pharmacies receive a prescription for quetiapine extended-release, they will need to submit brand name Seroquel XR in order to receive a paid claim. If a prescription for quetiapine extended-release is submitted instead of brand name Seroquel XR, the claim will reject at point-of-sale (POS) with the following reject message:

• NCPDP Reject Code 70: "Prod/Service Not Covered"

• Secondary Message: "Generic not covered, Seroquel XR covered. Please resubmit for brand. Seroquel XR pays at Tier 1 benefit"

For questions regarding coverage of Seroquel XR, please refer Covered Persons to the Customer Service number on the back of their BCBSKS ID card.

If you have any questions regarding claims processing, please call the Prime Contact Center at 800.821.4795.

Sincerely,

Pharmacy Network Management

Prime Therapeutics LLC

*Coverage of Seroquel XR is dependent on the Covered Person’s benefit plan