Retail claims transitioning from US Script pharmacy networks to pharmacy networks contracted and managed by CVS/caremark for members enrolled in Ambetter from MHS 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, Specialty, Compound, Vaccine Please contact US Script if you have any questions regarding pharmacy benefits processing for Ambetter from MHS 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: 1-855-339-4810

Retail claims transitioning from US Script pharmacy networks to pharmacy networks contracted and managed by CVS/caremark for members enrolled in Ambetter from Magnolia Health 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, Specialty, Compound, Vaccine Please contact US Script if you have any questions regarding pharmacy benefits processing for Ambetter from Magnolia Health 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: 1-855-339-4807

This week's Advocacy Center Update details legislative work on the nation's opioid abuse problem, track and trace pilot projects, and more...

Effective March 22, 2016, generic Nasonex® (Mometasone nasal spray) became available in the market. However, Mometasone nasal spray remained Non-Formulary for Medicare Part D Covered Persons. The innovator product Nasonex ® will continue to be covered without prior approval* from the plan. Action Required If Participating Pharmacies receive a prescription for Mometasone nasal spray for a Medicare Part D Covered Person, they will need to submit brand name Nasonex ® in order to receive a paid claim. If a prescription for Mometasone nasal spray is submitted instead of brand name Nasonex ®, the claim will reject at point-of-sale (POS) with the following reject message:  NCPDP Reject Code MR: Drug Not on Formulary  Secondary Message: Nasonex = Formulary, Mometasone Nasal = NonFormulary For

OptumRx will be performing scheduled maintenance to our claim processing system on Saturday, April 23 from 9:00p.m. (PT) until 5:00 a.m. (PT) Sunday, April 24. Actual maintenance time required for this outage may be reduced, at which point OptumRx will resume processing claims and other functions earlier. Pharmacies will be unable to process claims during the scheduled outage. The Pharmacy Help Desk will not be able to answer eligibility or benefit questions during this down time. We apologize for any inconvenience this may cause.