OPUS Health would like to inform you of the following new Copay Assistance Program(s) (see list below). This new program can be viewed on the OPUS Health Pharmacy Portal. Please use the link below to log in and select View New or Modified Programs to view the new program. If you have already created an account, use the email address and password you created to log in. If you do not have an account, please click on the link below and select Create Account to register. Registering takes just a minute or two and provides access to this and all active programs ? even some printable offers you can provide for your pharmacy customers.

Effective January 1, 2017, CVS Caremark® will begin to administer the prescription benefits for Medica’s Commercial employer group business. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark.

*Please see attached PDF for more information.

As a reminder, Qualified Medicare Beneficiaries (QMBs), including some UnitedHealthcare Medicare Advantage members, are not responsible for any remaining balance after payment from Medicare for covered services. The Centers for Medicare & Medicaid Services (CMS) guidelines state that Medicare-contracted care providers may not collect cost-share from these patients.

To determine if you can bill Medicaid as the secondary payer, please review the information found in the Benefit Stage Qualifier field of the approved Medicare Advantage claim. Code 50 in that field indicates that the claim was paid under Part B benefits, even if the drugs were processed using a Part D Processor ID or control number. This is because Medicare Advantage, also known as Part C, combines Part A, Part B and Part D benefits. If this is the case and the member is an active QMB, you can bill the dollar amount found in the Qualifier Amount field to Medicaid.