Dear Pharmacy:

This notification is to inform you of point-of-sale (POS) drug utilization review (DUR) edits which are being enforced by Virginia Premier Health Plan, processed by EnvisionRx effective October 01, 2016.

The attached sheet describes in detail the steps needed to properly evaluate and/or adjudicate the DUR edits as they may arise for claims with a Morphine Equivalent Dose (MED) > 90.

Should you have any questions, please contact our VPHP Pharmacy Help Desk at 1-855-872-0005.

Sincerely,

EnvisionRxOptions

*Please see attached PDF for more information.

Molina Healthcare of Florida administers prescription benefits throughout the State of Florida. After a detailed analysis considering time, distance, patient volume and costs, Molina Healthcare of Florida is changing its pharmacy network that serves its Marketplace members. Beginning November 1, 2016, members will only be allowed to fill covered prescriptions at pharmacy providers in the custom network. Your facility is not included in this custom network.

Molina Healthcare is always striving to ensure its members have access to care to meet their healthcare needs.

Your cooperation in guiding the membership affected by this change, and facilitating the transfer of prescriptions refills for these members to network providers, will be greatly appreciated.

APCI has received notice from several of our members that MedImpact is now recouping amounts based on DAW audits for prescriptions filled via e-script. These scripts were not deemed valid at the date of fill, because a law passed many years ago requiring the physician to write in his/her own handwriting on the face of the prescription either “medically necessary”, “do not substitute” or “dispensed as written.”

Dear Valued Provider,

On October 26, 2016, generic Benicar (olmesartan) and Benicar HCT (olmesartan/HCTZ) will become available to the market. Olmesartan and olmesartan/HCTZ hydrochlorothiazide will not be covered by Blue Cross and Blue Shield Kansas (BCBSKS) until multiple manufacturers become available or the price decreases. The innovator products, Benicar and Benicar HCT, will continue to be covered*.

Action Required

If Participating Pharmacies receive a prescription for olmesartan or olmesartan/HCTZ, they must submit brand name Benicar or Benicar HCT in order to receive a paid claim. If a prescription for olmesartan or olmesartan/HCTZ is submitted instead of brand name Benicar or Benicar HCT, 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, Benicar/Benicar HCT covered. Please resubmit for brand. Benicar/Benicar HCT pays at Tier 1 benefit"

For questions regarding coverage of Benicar or Benicar HCT, 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 Benicar or Benicar HCT is dependent on the Covered Person’s benefit plan