Dear Valued Provider,

Effective October 26, 2016, generic Benicar(olmesartan) and generic Benicar HCT(olmesartan/HTCZ) will become available to the market. These generics will not be covered by Blue Cross and Blue Shield of Wyoming 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/HTCZ, they must submit brand name Benicar /Benicar HCT in order to receive a paid claim. If prescriptions for olmesartan or olmesartan/HTCZ are submitted instead of brand name Benicar / 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 Blue Cross and Blue Shield of Wyoming 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

Recently, important system functionality required that claims for drugs dispensed in their smallest available marketed package size (unbreakable packages) must be submitted with the correct days’ supply for the submitted quantity.

Medications in “Unbreakable Packages” are those that must be dispensed in their original container/package and cannot be opened or broken. Please submit these claims with a day supply that is consistent with the dosing instructions on the prescription, even if the day supply exceeds the pharmacy contract.

*Please see attached PDF for more information.

RXBIN: 004336

RXPCN: MEDDADV

RXGRP: RXCVSD

The generic for Xopenex HFA Inhalation Aerosol recently became available in the marketplace; however, effective October 21, 2016, SilverScript will continue to cover the brand name Xopenex HFA at the Preferred Brand Tier.

The generic (levalbuterol tartrate HFA inhalation aerosol) will NOT be covered for SilverScript plan members. Please continue to dispense Xopenex HFA as prescribed rather than substituting the generic. If claims for the generic are submitted, the following reject will occur:

Reject 70 <<Dispense Brand – Xopenex HFA>>

If you need assistance, call the Pharmacy Help Desk at 1-866-693-4620.

Note: This does not apply to SilverScript Employer PDP plans.