UnitedHealthcare Commercial Business

BIN: 610279

Transition of Care is an existing process that allows a one-time, one-month override for certain medications previously filled by a member that are now subject to a strategic prescription drug list (PDL) exclusion or new utilization management program (e.g., Prior Authorization or Step Therapy). This program is available to new and existing UnitedHealthcare Commercial Business members. The one-time override will offer a grace period to members, giving them more time to speak with their physician or care provider about:

• Switching to a preferred or covered alternative, and/or
• Satisfying the drug’s clinical program requirements

Members (not the pharmacy) should contact a member call center representative (number on the back of their card) to determine if their medication is eligible for Transition of Care. If eligible, an override will be issued real time and the member will have five days to fill the medication once the override is placed. Please note that specialty medications are not eligible for a Transition of Care override. This will also not cover other rejections such as Refill Too Soon or pharmacy network requirements.

Dear Valued Provider,

Effective January 1, 2017, CVS Pharmacies will no longer participate in certain Prime networks. As a result of this processing change, your Participating Pharmacy may see an increase in Covered Person prescription claims and transfers.

Impacted Covered Persons are being notified of this change.

We sincerely appreciate your assistance to help prevent any disruption of service for these Covered Persons during this time.

If you have questions regarding claims processing, please contact Prime’s Contact Center at 800.821.4795. 

Sincerely,

Pharmacy Network Management

Prime Therapeutics LLC

Attached please find the presentation for today’s webinar.  An FAQ document will be provided post webinar for any questions submitted to the ProviderOutreach@esrxcommunications.com.

*Please see attached PDF for more information.

Effective January 1, 2017, CVS Caremark® will begin to administer the prescription benefits for Thompson Hine. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark.

RXBIN: 004336

RXPCN: ADV

RXGRP: RX0453

Member ID Format: 11 digits, numeric only

Person Code: 2 digits, required

Card images are not available at this time.

Patient Pay Amount

Please rely on the claims system to determine the correct amount to collect from the plan member, if applicable.