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.

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

Background As previously communicated on November 25, 2015, effective January 1, 2016, proration of a member’s daily cost share (copayment) in order to support the synchronization of prescription fills is being implemented by select fully-insured commercial and some State Medicaid and Marketplace Plan Sponsors. When implemented by a Plan Sponsor, this functionality will apply a daily cost-sharing rate to a prescription presented to a network pharmacy that is dispensed for less than the plan-defined one-month supply. IMPORTANT FOR PROVIDERS IN OHIO: Per OH Gen Assembly Sub. H.B. No.116, Section 1751.68 [Effective 8/31/2016], Provisions for medication synchronization for enrollees: An agreement that provides for medication synchronization by adhering to all of the stated conditions shall permit and apply a prorated daily cost-sharing rate for a supply of a prescription drug subject to medication synchronization that is dispensed at a network pharmacy.

Effective September 1, 2016, CVS Caremark® will begin to administer the prescription benefits for Venezia Transport. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark. RXBIN: 004336 RXPCN: ADV RXGRP: RX0317 Member ID Format: 9 digits, alpha only Person Code : 2 digits, required

Effective August 1, 2016, many Plan Sponsors began to reimburse pharmacies for the dispensing and administration of vaccines. Please note that the vaccines covered can vary on a Plan Sponsor-by-Plan Sponsor basis. This communication provides a list of participating plan sponsors as of August 30, 2016. NOTE: The information provided in this notice is intended to assist participating Providers with claim submission. If you do not participate and do not intend to participate in a particular client-specific or other contracted vaccine administration network, please disregard this information. Claims Submission Information When submitting administered vaccines claims to CVS Caremark, utilize “MA code processing” and NCPDP fields 44Ø -E5 and 438-E3. As a reminder—pharmacists are required to be certified and/or trained to administer vaccines. Please check with individual state boards of pharmacy to determine if pharmacists can administer vaccines in your respective state(s).