Effective 6/1/16, for UnitedHealthcare Community Plan of Florida members, you must review medications flagged with the reason code TD (Therapeutic Duplication) to resolve any duplication in the pharmacy system before dispensing the medication. TD is a safety edit that compares the member’s current medications to the drug you are processing. This reason code alerts you when a there is a request to fill a member’s medication within the same class as a medication already filled within the last 30 days so you can research why the patient is attempting to fill another medication in the same class so quickly.

RE: NO MAILING COVERED PRESCRIPTIONS SERVICES ON A “RETAIL” PHARMACY NETWORK AGREEMENTAs a reminder, your Network Pharmacy Provider participates in the OptumRx (“ORx”) retail network(s). You are receiving this reminder notice that Network Pharmacy Providers contracted directly or indirectly with ORx or its affiliate Catamaran (“CTRx”) pursuant to a retail pharmacy network agreement (“Agreements”) shall not solicit members for mail delivery or mail any covered prescription services to members. As further defined in the Agreements and Provider Manual (“Manual”), a Network Pharmacy Provider is prohibited from sending covered prescription services through the US mail or shipping via any common carrier (e.g. FedEx, UPS, DHL) to members (“Mailing”). Mailing covered prescription services is a violation of the Agreements and Manual and subjects the Network Pharmacy Provider to termination from all ORx’s and CTRx’s networks

Important Mirixa Notification

Additional CVS Caremark MTM Program Cases (CMR cases) have finished releasing to your pharmacy on the MirixaPro platform. Since Mirixa was unable to provide a forecast/case potential report for this release, they have gone ahead and added a one week extension to assist your pharmacy with case completion. The new due date for these cases will be June 2^nd.

This week's Generic News includes information on McKesson OneStop formulary changes, a new generic release by Perrigo, an obsolete product from Teva, and – as always – the current Generics Campaign.

Retail claims transitioning from US Script pharmacy networks to pharmacy networks contracted and managed by CVS/caremark for members enrolled in Peach State Health Plan will continue to process through US Script. • Claim processing BIN#: 008019 • Pharmacy Payment: Claims will be paid according to current US Script payment processing rules and payment cycles and will continue to appear on your US Script electronic 835 or remittance advice. The reimbursement calculation methodology will be the lesser of: (i) AWP Discount plus Dispensing Fee or (ii) MAC plus Dispensing Fee or (iii) U&C. This transition will not impact the following US Script pharmacy networks: Extended Day Supply, 340B, Specialty, Compound, Vaccine Please contact US Script if you have any questions regarding pharmacy benefits processing for Peach State Health Plan members. We look forward to working together to provide quality pharmacy services to these members. Please direct any questions regarding covered items to the US Script Help Desk at: 1-800-460-8988