This notification is provided to you pursuant to Texas Labor Code Section 408.0281(d) “Notification to Health Care Provider” and contains the information we may elect to provide to any person, other than an injured employee, to whom access has been provided to the contractual fee arrangement that National Pharmaceutical Service (NPS) has with you. This applies to contractual fee arrangements for services through the NPS network at rates inconsistent with the Texas workers’ compensation pharmacy fee guidelines.

Effective May 1, 2015, you may receive a prompt at the point-of-sale (POS) to verify diagnosis information for UnitedHealthcare Community Plan members in Texas. UnitedHealthcare will require an appropriate diagnosis for members age 19 and older who are taking ADHD drugs.UnitedHealthcare will also require an appropriate diagnosis for members taking: Alinia, Altabax, Lovaza, Propylthiouracil, Sitaglipt (Januvia), and Xifaxan (Rifaximin).

Beginning April 1, 2015, Express Scripts will be the pharmacy benefits manager (PBM) for Amerigroup Kansas members. Below are some important updates about the pharmacy benefit for these members.

ATTENTION PHARMACISTS:
IMPORTANT MEMBER ADJUDICATION NOTIFICATION

Effective April 1, 2015, Managed Health Services (MHS) will be expanding with the introduction of the Hoosier Care Connect (HCC) Aged, Blind, and Disable (ABD) program, adding an additional 20,000 members. Pharmacies should process claims for MHS Hoosier Care Connect members through: