About APCI

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Since 1984, APCI has been the ‘united voice of independent pharmacy’

APCI began as a small buying group for a limited number of independent pharmacies in central Alabama. Since that time, the cooperative has grown to more than 1,800 members pharmacies in 26 states, and provides its members with a wide range of products and services.

Our mission is to represent the economic and professional interests of independent pharmacies by providing leadership, vision, and a collective voice for our members in the healthcare marketplace. Our goal is to level the playing field for our member pharmacies by providing innovative, targeted programs to benefit our entire membership.

2

Sep

2016

OptumRx: Avoid Penalties by Not Collecting Cost-Share for Covered Medicare Services from Qualified Medicare Beneficiaries

Effective:

As a reminder, Qualified Medicare Beneficiaries (QMBs), including some UnitedHealthcare Medicare Advantage members, are not responsible for any remaining balance after payment from Medicare for covered services. The Centers for Medicare & Medicaid Services (CMS) guidelines state that Medicare-contracted care providers may not collect cost-share from these patients. To determine if you can bill Medicaid as the secondary payer, please review the information found in the Benefit Stage Qualifier field of the approved Medicare Advantage claim. Code 50 in that field indicates that the claim was paid under Part B benefits, even if the drugs were processed using a Part D Processor ID or control number. This is because Medicare Advantage, also known as Part C, combines Part A, Part B and Part D benefits. If this is the case and the member is an active QMB, you can bill the dollar amount found in the Qualifier Amount field to Medicaid. If Medicaid does reimburse you, that payment must be accepted as full payment. If a balance remains or you’re unable to bill Medicaid as the secondary payer, your office must provide medications or supplies to UnitedHealthcare Medicare Advantage members without billing them for the balance. Care providers who bill patients who are QMBs for any remaining balances may be penalized as established in Section 1902(n)(3)(C) of the Social Security Act. If you have any questions, please call the following OptumRx Help Desk numbers any time. Thank you.

2

Sep

2016

Express Scripts: Emergency Override for "Refill Too Soon" due to Tropical Storm in Florida

Effective: Immediately

The governor of Florida has extended the State of Emergency to include the following counties: Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Washington, Manatee, Osceola, and Sarasota. These counties are in addition to the original counties included in the declaration: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hernando, Hillsborough, Jackson, Jefferson, Lafayette, Lake, Leon, Levy, Liberty, Madison, Marion, Nassau, Orange, Pasco, Pinellas, Polk, Putnam, Seminole, St. Johns, Sumter, Suwannee, Taylor, Union, Volusia and Wakulla. Due to this issuance, Express Scripts has implemented Emergency Refill Too Soon Procedures in the state of Florida for Part D and Medicare Advantage plans. Effective immediately, if a patient from the disaster area attempts to fill a prescription for lost or damaged medication resulting from the disaster, and the claim rejects with a Reject 79 "Refill Too Soon," the pharmacy should enter override code 91100000001 in NCPDP vD.0 field 462-EV "Prior Auth Number Submitted."

2

Sep

2016

Magellan: Addition of Maxium Allowable Cost (MAC) Pricing to Diabetic Supplies

Effective: September 5, 2016

Addition of Maximum Allowable Cost (MAC) Pricing to Diabetic Supplies Magellan Medicaid Administration implemented a new MAC to all lancets effective August 24, 2016. Additionally, all other diabetic supplies will be subject to MAC pricing effective September 5, 2016. Please make a note of the new pricing below to ensure that you are purchasing and billing for the lowest cost alternative for these supplies.

2

Sep

2016

Magellan: PREFERRED DRUG LIST (PDL) FOR TENNCARE

Effective: October 1, 2016

This notice is being sent to notify you of changes for the TennCare pharmacy program. We encourage you to read this notice thoroughly and contact Magellan’s Pharmacy Support Center (866-434-5520) should you have additional questions. PREFERRED DRUG LIST (PDL) FOR TENNCARE EFFECTIVE 10-1-16 TennCare is continuing the process of reviewing all covered drug classes. Changes to the PDL may occur as new classes are reviewed and previously reviewed classes are revisited. As a result of these changes, some medications your patients are now taking may be considered non-preferred agents in the future. Please inform your patients who are on these medications that switching to preferred products will decrease delays in receiving their medications. A copy of the new PDL will be posted October 1, 2016 to https://tenncare.magellanhealth.com. We encourage you to share this information with other TennCare providers. The individual changes to the PDL are listed below. For more details on clinical criteria, please visit: https://tenncare.magellanhealth.com

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