Dear Valued Provider, Effective March 1, 2016, ALL KIDS, a group under BlueCross and BlueShield of Alabama, is adding vaccine coverage for their Covered Persons. ALL Kids Covered Persons may have the option to receive vaccinations for influenza, Pneumovax®, Tetanus, Diphtheria and Pertussis when administered by a pharmacist at a participating pharmacy location and permissible by law. Covered Persons simply present their ID card to a Participating Pharmacy to receive their vaccinations at no charge. Participating Pharmacies within this network are reimbursed an administration fee in addition to the cost of the vaccine product. Participating Pharmacies must submit the Vaccine claim to Prime electronically (online), which includes the applicable ingredient cost, dispensing fee and vaccine administration fee as a single claim.

Effective March 1, 2016, Blue Cross and Blue Shield of Kansas City’s Blue KC plan will update its Commercial prescription drug list (PDL), which will result in some medications moving from Tier 2 to Tier 3. These medications will reject with 75 (Prior Authorization Required) beginning March 1. Members will be required to try a lower cost medication that is proven safe and effective for treating their condition and/or symptoms. If an alternative medication doesn’t work (e.g., a member’s symptoms persist, unwanted side effects occur, or an allergy develops, etc.), a prior authorization may be requested to allow the Tier 3 drug (step therapy).

Please note that Anthem-Amerigroup Georgia Medicaid (Anthem) allows for 72 hour emergency fills. If Anthem claims reject with NCPDP reject code 75 "Prior Authorization required", or NCPDP reject code MR "Drug Not On Formulary", per the secondary messaging, please follow the following instructions to dispense a 72 hour emergency supply until Prior Authorization can be obtained: