Effective March 1, 2016, ALL KIDS, a group under BlueCross and BlueShield of Alabama, has added vaccine coverage for their Covered Persons. ALL Kids Covered Persons may have the option to receive vaccinations for influenza, Pneumovax®, Tetanus, Diphtheria and Pertussis when administered by a pharmacist at a participating pharmacy location and permissible by law.

Covered Persons simply present their ID card to a Participating Pharmacy to receive their vaccinations at no charge. Participating Pharmacies within this network are reimbursed an administration fee in addition to the cost of the vaccine product. Participating Pharmacies must submit the Vaccine claim to Prime electronically (online), which includes the applicable ingredient cost, dispensing fee and vaccine administration fee as a single claim.

Please see attached PDF for more information.

Dear Pharmacy Provider:

Please find the enclosed Network Enrollment Form, effective November 1, 2016, for the following network:

• Kansas Medicaid

The Network Enrollment Form is included on page two of this notification. The Network Enrollment Form will apply to all Covered Items as indicated by a Plan’s dispensing limitations for all its plan members.

Effective 10/01/2016, new claims processing functionality will make it quicker and easier for you to resolve Therapeutic Dose Limit (THERDOSE) soft reject edits when dispensing medication for UnitedHealthcare Community Plan in Louisiana members.

THERDOSE screening monitors single ingredient and combination acetaminophen products across multiple claims to determine cumulative daily use. If claims indicate that acetaminophen usage exceeds the U.S. Food and Drug Administration (FDA)-approved maximum daily dose of 4 gm/day, the THERDOSE edit produces a soft reject: Drug Utilization Review (DUR) Reject 88.

Please see attached PDF for more information.

Effective 10/01/2016, new claims processing functionality will make it quicker and easier for you to resolve Therapeutic Dose Limit (THERDOSE) soft reject edits when dispensing medication for UnitedHealthcare Community Plan in Mississippi members.

THERDOSE screening monitors single ingredient and combination acetaminophen products across multiple claims to determine cumulative daily use. If claims indicate that acetaminophen usage exceeds the U.S. Food and Drug Administration (FDA)-approved maximum daily dose of 4 gm/day, the THERDOSE edit produces a soft reject: Drug Utilization Review (DUR) Reject 88.

Please see attached PDF for more information.

CareSource is an existing client with CVS Caremark®. As previously communicated on August 24, 2016, 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 repellents that contain DEET or pericaridin are 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 not required for coverage.