Pharmacists must be sure to enter the proper billing unit when dispensing vaccines. The correct billed quantity for these products should be based on the number of milliliters, but Express Scripts is aware that some pharmacies are submitting the quantity as the number of vaccines rather than the volume of product contained in each vaccine. As a result, claims are being billed for significantly higher amounts than the actual quantity of product dispensed.

The polio vaccine, or IPOL, and standard flu vaccines are prime examples. These vaccines are dispensed at 0.5mL for one dose. A quantity dispensed of 0.5 should be submitted on the claim to indicate the actual volume of product dispensed, rather than the number one (1) to indicate the number of vaccines dispensed

Inside this weekly you will find:

• Proper Billing for Vaccine Products
• NY Opioid Prescription Limit
• Anthem Formulary Updates

*Please see attached PDF for more information.

Asacol® HD

SilverScript

• RXBIN: 004336
• RXPCN: MEDDADV
• RXGRP: RXCVSD

The generic for Asacol HD recently became available in the marketplace; however, effective September 23, 2016, SilverScript will continue to cover the brand name Asacol HD at the Non-Preferred Brand Tier.

The CVS Caremark® Pharmacy Performance Department is providing its Network Pharmacies with a reminder regarding your pharmacy’s contractual requirements with respect to accurate claims billing and dispensing.

Notice from the Texas Health and Human Services Commission to Pharmacies:

Mosquito Repellent Benefit

Following are claims processing, eligibility and benefit information specific to the mosquito repellent benefit to prevent Zika virus transmission.

Covered programs:

• Medicaid – Managed Care (MCO) and Fee-for-Service (FFS)
• Children's Health Insurance Program (CHIP) and CHIP-Perinate
• Healthy Texas Women

*Please see attached PDF for more information.