Beginning April 1, 2016, Express Scripts will be the pharmacy benefits manager (PBM) for Amerigroup Iowa Medicaid members. As a reminder, following are some important updates about the pharmacy benefit for these members. Member Eligibility Verification Below are sample ID cards for Amerigroup Medicaid members:

US Script and CVS/caremark are pleased to announce that beginning on or after April 18, 2016, select US Script plans (noted on left) will begin utilizing CVS/caremark’s provider agreements, which includes CVS/caremark’s pharmacy networks and reimbursement terms, except as may otherwise be communicated by US Script. However, claims processing and payment processing will remain the same (via US Script).Claims Processing Information & Help Desk InformationNo changes need to be made when submitting claims for US Script plan members.Plan members will be able to continue using pharmacies contracted with CVS/caremark without disruption, and there will be no changes to the current RXBIN, RXPCN (if applicable) information for Commercial, Medicaid or Marketplace plans at this time.

Express Scripts administers the pharmacy benefit for Amerigroup members. Effective April 1, 2016, the following benefit changes will be implemented for these members. Claims Reimbursement Beginning April 1, 2016, reimbursement for Amerigroup Medicaid/CHIP claims will be based on the National Average Drug Acquisition Cost (NADAC) as posted by CMS. If the NADAC price is not available for a drug, the rates contracted for this plan sponsor will apply. Maximum Allowable Cost (MAC) pricing will not be applied to an Amerigroup Medicaid/CHIP claim if a NADAC price is available. Claims excluded from NADAC pricing will be as follows:  Claims for members designated as "Medically Needy" with an unmet spenddown balance.  Claims for members with other primary prescription insurance (TPL).

OutcomesMTM will release a new Needs Medication Synchronization TIP for select plans this week. Pharmacies that successfully complete this exciting new service will earn up to a $50 MTM service fee per claim.

Thank you for participating in the CVS Caremark 2016 Performance Network Program. This fax is the third in a series of four faxes your pharmacy will receive in March. Please read and keep these faxes so your pharmacy can refer to program details in order to achieve the best level of performance—which directly correlates to your pharmacy reimbursement rates, your pharmacy Pay Per Intervention (PPI) through Mirixa, and your end-of-year performance payment, if applicable. The third week fax includes 2016 Timeline of Measurement, Calculation and Collection Periods—see below.