Effective 6/1/16, for UnitedHealthcare Community Plan of Louisiana 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.

This week's Advocacy Update includes information on the House's "Opioid Week", TRICARE developments, and a final Medicaid Managed Care Rule from CMS.

CMS' Average Manufacturer Price (AMP) based Federal Upper Limits (FUL), which has set new federally established maximum allowable costs (MAC) for a number of generics, will be implemented starting Sunday, May 1.

Effective 6/1/16, for UnitedHealthcare Community Plan of Florida 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.

RE: NO MAILING COVERED PRESCRIPTIONS SERVICES ON A “RETAIL” PHARMACY NETWORK AGREEMENTAs a reminder, your Network Pharmacy Provider participates in the OptumRx (“ORx”) retail network(s). You are receiving this reminder notice that Network Pharmacy Providers contracted directly or indirectly with ORx or its affiliate Catamaran (“CTRx”) pursuant to a retail pharmacy network agreement (“Agreements”) shall not solicit members for mail delivery or mail any covered prescription services to members. As further defined in the Agreements and Provider Manual (“Manual”), a Network Pharmacy Provider is prohibited from sending covered prescription services through the US mail or shipping via any common carrier (e.g. FedEx, UPS, DHL) to members (“Mailing”). Mailing covered prescription services is a violation of the Agreements and Manual and subjects the Network Pharmacy Provider to termination from all ORx’s and CTRx’s networks