This notification is to advise pharmacy providers of future formulary changes in the MedImpact Healthcare Systems, Inc. Medicare Part D Formularies. A list of drugs along with the description of the change and effective date is included in the formulary change portion of this notification which is available on the ChainDrugStore.net network (www.chaindrugstore.net). These changes will go into effect in 60 days coinciding with CMS required 60 days notice to Beneficiaries of any negative formulary changes.

Please see the attached excel documents for more information regarding the formulary changes.

As previously communicated by US Script and CVS Caremark®, Peach State Health Plan began using the CVS Caremark pharmacy network on May 2, 2016, while claims processing and payment remained with US Script. This notice is to inform you that effective September 1, 2016, CVS Caremark will begin to process claims for Peach State Health Plan. All claims for Peach State Health Plan will now be reimbursed according to your CVS Caremark Network Enrollment Forms and be paid according to CVS Caremark processing rules and payment cycles, which will appear on your CVS Caremark 835 or remittance advice.

The following table lists the brand name drug that will have a utilization management restriction added: