Hepatitis C drugs "carved out" of managed care Effective September 1, 2016, all covered hepatitis C drugs will be reimbursed through the fee-for-service (FFS) pharmacy benefit manager (PBM), OptumRx, including those dispensed to members enrolled in managed care programs. This change is referred to as a "carve out" of the hepatitis C pharmacy benefit from managed care. All Healthy Indiana Plan (HIP) and Hoosier Care Connect hepatitis C drug claims that are currently processed by Anthem, MDwise, or Managed Health Services (MHS) PBMs will be processed by OptumRx for dates of service (DOS) on or after September 1, 2016. Hepatitis C drug claims for Hoosier Healthwise managed care members will continue to be processed by OptumRx as they are currently.

Effective 09/15/2016, for UnitedHealthcare Community Plan of Mississippi members, you must review medications flagged with the reason code TD (Therapeutic Duplication) to resolve any duplication in the pharmacy system before dispensing the medication. TD is a safety edit that compares the member’s current medications to the drug you are processing. This reason code alerts you when a there is a request to fill a member’s medication within the same class as a medication already filled within the last 30 days so you can research why the patient is attempting to fill another medication in the same class so quickly. When the pharmacy system flags a medication for TD, it produces a soft reject and will display the message: TD: ANOTHER [specific drug class] PRODUCT WAS FILLED.