This week's update includes information on community pharmacy champion Rep. Doug Collins, legislative action on opioid abuse, and more!

RXBIN: 610591

RXPCN: ADV

RXGRP: RX8831

Effective February 1, 2016, CVS Caremark® began to administer the prescription benefits for Aetna Better Health of Kentucky (formerly known as Coventry Cares of Kentucky). The information below is being provided to assist your pharmacy with the following common rejects:

Reject 70: Product/Service Not Covered

Reject 75: Prior Authorization Required

Reject 76: Plan Limitations Exceeded

Beginning April 1, 2016, Express Scripts will be the pharmacy benefits manager (PBM) for Amerigroup Iowa Medicaid members. As a reminder, following are some important updates about the pharmacy benefit for these members. Member Eligibility Verification Below are sample ID cards for Amerigroup Medicaid members:

US Script and CVS/caremark are pleased to announce that beginning on or after April 18, 2016, select US Script plans (noted on left) will begin utilizing CVS/caremark’s provider agreements, which includes CVS/caremark’s pharmacy networks and reimbursement terms, except as may otherwise be communicated by US Script. However, claims processing and payment processing will remain the same (via US Script).Claims Processing Information & Help Desk InformationNo changes need to be made when submitting claims for US Script plan members.Plan members will be able to continue using pharmacies contracted with CVS/caremark without disruption, and there will be no changes to the current RXBIN, RXPCN (if applicable) information for Commercial, Medicaid or Marketplace plans at this time.

Express Scripts administers the pharmacy benefit for Amerigroup members. Effective April 1, 2016, the following benefit changes will be implemented for these members. Claims Reimbursement Beginning April 1, 2016, reimbursement for Amerigroup Medicaid/CHIP claims will be based on the National Average Drug Acquisition Cost (NADAC) as posted by CMS. If the NADAC price is not available for a drug, the rates contracted for this plan sponsor will apply. Maximum Allowable Cost (MAC) pricing will not be applied to an Amerigroup Medicaid/CHIP claim if a NADAC price is available. Claims excluded from NADAC pricing will be as follows:  Claims for members designated as "Medically Needy" with an unmet spenddown balance.  Claims for members with other primary prescription insurance (TPL).