WellCare Health Plans, Inc.

‘Ohana Health Plans

Easy Choice Health Plan

RXBIN: 004336

RXPCN: MEDDADV

RXGRP: 788257

WellCare is an existing client with CVS Caremark®. As a reminder, CMS guidelines prohibit Medicare-contracted Providers from collecting cost-share for Medicare-covered services from Qualified Medicare Beneficiaries (QMBs), including some WellCare members.

QMBs have no legal obligation to make further payment to a Provider for Part B-covered medications/supplies. Balances should be billed to Medicaid as the secondary payer. Per CMS guidelines, if a full or partial balance remains after billing Medicaid, or if the Provider is unable to bill Medicaid, they are still required to dispense the medication/supply without balance billing the beneficiary. Providers who inappropriately bill QMB patients may be subject to sanctions as established in Section 1902(n)(3)(C) of the Social Security Act.

Texas now covers mosquito repellents for the prevention of Zika virus. The following notice describes claims processing, eligibility, and benefit information specific to the mosquito repellent benefit for the below programs.

Covered Programs:

• Medicaid
• Children's Health Insurance Program (CHIP) and CHIP- Perinate
• Healthy Texas Women

*Please see attached PDF for more information.

Per Novo Nordisk, untreated hypoglycemia can lead to serious effects such as unconsciousness and seizures. If blood glucose levels are not quickly restored, hypoglycemia can lead to cognitive dysfunction, sweating, tremors, convulsion, coma, and possibly death.

Please see attached PDF for more information. 

As a reminder, effective September 1, 2016, CVS Caremark® began to administer the prescription benefits for Passport Health Plan. Please update or create plan member profiles to reflect the following changes regarding the new plan adjudicating through CVS Caremark.

Please see attached PDF for more information.

Paramount Advantage is an existing client with CVS Caremark®. Effective for dates of service on or after June 6, 2016, Ohio Medicaid covers insect repellent in response to the urgent public health issue associated with the Zika virus. Insect repellent is covered for any Medicaid consumer when appropriate to aid in preventing infection with the Zika virus. A prescription for insect repellent from an eligible Medicaid prescriber is required for coverage.

Please see attached PDF for more information.