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.

Pharmacies participating in the vaccine service network may process the influenza vaccine at the point of service for STAR members ages 18 and older and CHIP Perinate mothers ages 18 and older.

Inside this edition, you will find: 

• How Do Pharmacies Maintain Compliance with CMS?
• Formulary Changes

Please see attached PDF for entire newsletter.