In the "Iowa Addendum to Caremark Provider Agreement" (beginning on page 133), a new section is added to read as follows, right after section 6:

To the extent that Provider provides Pharmacy Services to Eligible Persons enrolled in Managed Care Organizations ("Plan Sponsor") contracting with the Iowa Medicaid Managed Care Program, Provider agrees to the following provisions, if applicable:

Title: Hoosier Care Connect Members Will Have Copays in 2016

Beginning January 1, 2016, all Hoosier Care Connect members will be responsible for paying a copayment for certain medical and pharmacy services, regardless of health plan selection. Members are responsible for copayments for transportation, non-emergent Emergency Room visits and pharmacy services at the time of service.

Copay Amounts

The following services will have a copay in 2016:

• Transportation - $1 one way/$2 round trip
• Prescription medication – $3 (per prescription)
• Non-emergent Emergency Room Visit – $3 (this means using the ER for non-emergency purposes)

Copay Exceptions

• Members who are pregnant, of Native American descent, less than 18 years of age or have already met their 5% cost sharing max will be exempt from copays.
• Medications for family planning will be exempt from copays.
• Transportation copays will be waived when transportation services are for an MHS education events or Member Advisory Council (MAC) meetings.

A Medicaid provider cannot deny care or services to an individual due to failure of payment.

Learn more about member copays in the MHS Provider Manual.

Aetna began using a new RxGroup for Medicare Part D for new Aetna members beginning in August. Existing Aetna members will receive new ID cards with new claims processing information. Pharmacies are advised to proactively update member profiles NOW in advance of the RxGroup edit becoming effective on January 1, 2016. Please review the information below for accurate claims submission information.

Dear Valued Provider, Effective January 1, 2016, Blue Cross and Blue Shield of Alabama is adding a new definition to their prescription drug guidelines for Commercial and Health Insurance Marketplace (HIM) plans. This definition clarifies coverage of prescription products approved by the Food and Drug Administration (FDA). Prescriptions for products not approved by the FDA are not covered. FDA-approved drug coverage will be defined as follows: coverage is limited to prescription products approved by the Food and Drug Administration (FDA) as evidenced by a New Drug Application (NDA), Abbreviated New Drug Application (ANDA), or Biologics License Application (BLA) on file. Any legal requirements or group specific benefits for coverage will supersede this (e.g., preventive drugs per the Affordable Care Act).