Aetna began using a new RxGroup for Medicare Part D for new Aetna members beginning in August. Existing Aetna members will receive new ID cards with new claims processing information. Pharmacies are advised to proactively update member profiles NOW in advance of the RxGroup edit becoming effective on January 1, 2016. Please review the information below for accurate claims submission information.

Dear Valued Provider, Effective January 1, 2016, Blue Cross and Blue Shield of Alabama is adding a new definition to their prescription drug guidelines for Commercial and Health Insurance Marketplace (HIM) plans. This definition clarifies coverage of prescription products approved by the Food and Drug Administration (FDA). Prescriptions for products not approved by the FDA are not covered. FDA-approved drug coverage will be defined as follows: coverage is limited to prescription products approved by the Food and Drug Administration (FDA) as evidenced by a New Drug Application (NDA), Abbreviated New Drug Application (ANDA), or Biologics License Application (BLA) on file. Any legal requirements or group specific benefits for coverage will supersede this (e.g., preventive drugs per the Affordable Care Act).

Optum Rx will be performing scheduled maintenance to our claim processing system on Saturday, December 12 from 9:00p.m. (PT) until 4:00 a.m. (PT) Sunday, December 13. Actual maintenance time required for this outage may be reduced, at which point OptumRx will resume processing claims and other functions earlier.

Pharmacies will be unable to process claims during the scheduled outage. The Pharmacy Help Desk will not be able to answer eligibility or benefit questions during this down time. We apologize for any inconvenience this may cause.