Dear Pharmacy Provider,

Please find attached the 2016-2017 MagellanRx Pharmacy Network Fee Schedule VAC-16 which updates the current reimbursement for vaccines covered under our Commercial and Medicaid lines of business that elect to cover vaccines along with Medicare Part D:

• VAC-16 replaces Pharmacy Network Fee Schedule VAC-15 and will be utilized for Medicare Part D and Commercial and Medicaid plans where vaccines are covered under the pharmacy benefit for the 2016-2017 flu season.

October 17, 2016

Dear Pharmacy Network Provider,

In an effort to promote vaccine administration in the pharmacy, please make a concentrated effort to:

• Register as an Immunization Provider in NCPDP

This will enable us to identify and promote your service for Avera subscribers.

If you have any questions, please email us at Pharmacynetwork@performrx.com

Sincerely,

PerformRx

Pharmacy Network Department

Process for durable medical equipment (DME) billing for pharmacies

AmeriHealth Caritas Iowa has received a number of inquiries from pharmacies about our DME billing process. Here are the key things pharmacies need to know when submitting DME claims:

• PerformRx is not able to process DME claims through their pharmacy point-of-sale system.
• Pharmacies that provide DME supplies must submit claims to AmeriHealth Caritas Iowa in order for claims to be processed.
• To submit a DME claim, pharmacies and/or DME suppliers can use the CMS-1500 professional claim form and submit electronically or via paper.

Effective November 1, 2016, CVS Caremark® will begin to administer the prescription benefits for Aetna Better Health of Texas STAR Kids. 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.

Effective November 1, 2016 – US Script will be changing its name to Envolve Pharmacy Solutions. Please make a note of it in your records.

Please contact Envolve Pharmacy Solutions if you have any questions regarding this company name change. We look forward to working together to provide quality pharmacy services to our members.