OptumRx has assumed responsibility for claims processing for members of Proliance Surgeons, Inc. Please Note:  All plan participants of Proliance Surgeons, Inc. will receive a new member identification (ID) card. Please refer to the sample of the new ID card below.  Prescriptions need to be processed on-line using the Proliance Surgeons, Inc. ID card information.

 All members of OM Group will receive a new member identification (ID) card as shown

 Please process prescriptions online using the OM Group ID card information.

MAC Pricing Changes   Date: January 7, 2016 What You Need to Know   Attention Argus WEST VIRGINIA Network Pharmacies:   The MCO (Managed Care Organizations for Medicaid) requires that you have the option to be notified in advance of changes to the generic pricing utilized for West Virginia Family Health beneficiaries.  Later this fall, we will be implementing enhancements to our Argus Pharmacy Portal which will allow you to subscribe to an alert system which will notify you when changes to the MAC pricing are being made.  When that enhancement is completed, we will send another bulletin with instructions on how to register for those alerts.   In the interim, we will be emailing the MAC changes to you at this email address.  If you wish to OPT OUT, please reply to the email notification and add “OPT OUT” to the subject line before sending.  We will gladly remove you from our distribution list. Action Required If you have any questions, please feel free to reach out to our MAC team via email to macinquiries@argushealth.com

Commercial Effective December 1, 2015 • Glumetza is excluded from the prescription benefit. The physician will not be able to request a prior authorization for continued coverage. • Capsaicin and menthol containing patches are excluded from the prescription benefit. The physician will not be able to request a prior authorization for continued coverage. • Specialty medications are limited to up to a 31 day supply fill. The physician will not be able to request a prior authorization for a larger day supply. Effective January 1, 2016 • Proton Pump Inhibitors (PPIs) will be excluded with the exception of generic Aciphex and Protonix. The physician will not be able to request a prior authorization for continued coverage on the excluded PPI products. • PPI products available in a liquid, packet, or sprinkle form a will require prior authorization. The physician can contact MedImpact at 800-788-2949 to request a Medication Request Form in order to initiate the prior authorization process.