CVS Caremark MTM Program will be releasing new cases on Friday, May 1st.    Each case will be available for 30 days and may be served face to face or telephonically. Pharmacy will be paid $60.00 for each case served. Pharmacies will not receive payments for any cases that are declined.

Effective November 13, 2014, the US Food and Drug Administration (FDA) changed the Orange Book rating of Methylphenidate Hydrochloride ER for the manufacturers Mallinckrodt and Kudco. As a result of this change, the FDA no longer recognizes Methylphenidate Hydrocholride ER from these manufacturers as the generic equivalent to Concerta.

Effective April 28, 2015, Prime Therapeutics (Prime) will no longer accept claims submitted with an incorrect Processor Control Number (PCN) for Covered Person’s of Blue Advantage and Blue RX.

If the Participating Pharmacy does not take immediate action to make the necessary software changes prior to this date, claims will reject. If a Medicare Part D claim is submitted with an invalid PCN on or after April 28, 2015, the following reject codes may be returned: 

• 01 – M/I BIN 
• 04 – M/I Processor Control Number 
• 06 – M/I Group Number

The purpose of this communication is to inform you of changes that will impact the processing and reconciliation of Prime Therapeutics payments. Please make the necessary modifications in your processes and communicate these changes to your pharmacies as you deem appropriate.

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