Dear Valued Provider,

On October 26th, 2016, generic Benicar and Benicar HCT (olmesartan and olmesartan/ HCTZ) will become available to the market. Olmesartan and olmesartan/HCTZ will require a Prior Authorization by Florida Blue until multiple manufacturers become available or the price decreases. The innovator product Benicar/HCT will continue to be covered*.

Action Required

If Participating Pharmacies receive a prescription for olmesartan or olmesartan/HCTZ, they will need to submit brand name Benicar/HCT in order to receive a paid claim. If a prescription for olmesartan or olmesartan/HCTZ is submitted instead of brand name Benicar/HCT, the claim will reject at point-of-sale (POS) with the following reject message:

• NCPDP Reject Code 75: Prior Authorization
• Secondary Message: "Brand Benicar/HCT preferred, generic requires PA"

For questions regarding coverage of Benicar/HCT 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

*Please see attached PDF for the revised communication to reflect the correct Line of Business.

Dear Valued Provider,

On October 26, 2016, generic Benicar and Benicar HCT (olmesartan and olmesartan/HCTZ) will become available to the market. Olemesartan and olmesartan/HCTZ will not be covered by Blue Cross and Blue Shield of Alabama until multiple manufacturers become available or the price decreases. The innovator products Benicar and Benicar HCT will continue to be covered with a tier 1 copay*.

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 HCT tablets 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: Olmesartan and Olmesartan HCT not covered, use Benicar or Benicar HCT

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

* For State of Alabama Covered Person’s only – brand Benicar and Benicar HCT will continue to process with a tier 4 copay.

* For Auburn University Covered Person’s only – brand Benicar and Benicar HCT will process with a tier 2 copay.

Please see the attached Payer Sheet for Script Care, Ltd. as the submission of standard NCPDP Telecommunication Standard Guide Version D.0, fields are required by Script Care, LTD Plan Sponsors and must be submitted during processing.

Effective January 1, 2017, CVS Caremark® will exclude coverage for all new-to-market unapproved products and certain existing unapproved products that may be marketed contrary to the Federal Food, Drug, and Cosmetic Act (FFDCA). Coverage will remain for select unapproved products that are legally marketed(1) or deemed clinically necessary (e.g., because no alternatives exist).

*Please see attached PDF for more information.