Dear Pharmacy Provider, The purpose of this letter is to notify you that effective January 1, 2016; PerformRx in coordination with AscellaHealth, will be providing pharmacy benefit management services for certain new client groups. All claims processing will be through Emdeon and governed by the terms and conditions of your PerformRx Participating Pharmacy Agreement. The fee schedule for this Plan is the same as the fee schedule in your national agreement(s).

RXBIN: 004336 RXPCN: MCAIDADV RXGRP: RX8896 Member ID Format: 7 numeric + 1 alpha Person Code: 2 digits Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for WellCare of Iowa, a Care Management Organization, in the Iowa Medicaid Program. WellCare of Iowa members will be transitioned to a network with CVS/caremark that continues to meet member access requirements, but may offer fewer Providers.

RXBIN: 004336 RXPCN: MCAIDADV RXGRP: RX8896 Member ID Format: 7 numeric + 1 alpha Person Code: 2 digits Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for WellCare of Iowa, a Care Management Organization, in the Iowa Medicaid Program. WellCare of Iowa members will be transitioned to a network with CVS/caremark that continues to meet member access requirements, but may offer fewer Providers.

Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for Heritage Home Group. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS/caremark. RXBIN: 004336 RXPCN: ADV RXGRP: RX0231 Member ID Format: 11 digits Person Code : 2 digits

All Medicaid prescriptions that are presented in-person at the pharmacy must be written on a tamper-resistant prescription pad. If, during auditing, a prescription is found that was not written on a tamper-resistant pad, that claim will be subject to chargeback.