INTotal Health is an existing plan sponsor with CVS Caremark®. Effective October 1, 2016, INTotal Health will make the formulary changes listed in this PDF.

Based on these changes, some medications may no longer be covered by the plan or may require additional Prescriber action to be covered.

• RXBIN: 004336
• RXPCN: ADV
• RXGRP: RX4037

*Please see attached PDF for more information.

New Plan Information

As of October 1st 2016, the Rx processing information for Fond du Lac Regional Clinic employees has changed. As a result of this change, members have received new ID cards and with a new BIN, PCN and RxGRP for prescription claims processing.

Enrollee Identification Cards

Eligible members have a new ID card with the new processing information. As of October 1st, 2016, all new pharmacy claims must be processed using the newly assigned numbers. During this transition, members may have two cards, so please be sure to reference this new card beginning October 1st.

Payer Sheets

In preparation for this transition, a new Payer Specification Sheet is available. We encourage you to review the Payer Specification sheet and contact your software vendor to make any necessary changes to support this transition.

*Please see attached PDF for more information.

• NCPDP Reject 39 (MISSING/INVALID DIAGNOSIS CODE)
• NCPDP REJECT CODE 614 (UPPER CASE REQUIRED)

*Please see attached PDF for more information.