Optum Rx will manage claims processing for members under KPS Health Plan’s new

 All members under KPS Health Plans will receive a new member identification (ID) card

 Please process prescriptions online using the following KPS Health Plans ID card

Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for Subaru of Indiana Automotive, Inc. 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: RX0201

Member ID Format 9 digits

Person Code 2 digits

Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for TMI Hospitality. 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: RX0200

Member ID Format: 9 digits

Person Code : 2 digits

Dear Pharmacy Provider,

Pursuant to state MAC regulations, please consider this to be notification that Tmesys has reviewed and instated a new MAC pricing list. 

Tmesys MAC pricing is determined by a third party vendor, Glass Box Analytics LLC, using the Predictive Acquisition Cost (PAC) model.  PAC pricing uses the following sources: industry MAC Benchmarks, published price lists, existing pricing benchmarks, behavioral metrics, and supply/demand measures.  PAC pricing also uses as a “source”, survey based drug acquisition costs obtained from CMS on the national level and pharmacy level pricing information as reported to state agencies from the following states: Arkansas, Colorado, Idaho, Louisiana, and Oregon.

Helios strives to ensure compliance with all state legislative and regulatory requirements related to the provision of pharmacy and ancillary services. Therefore, to receive information pursuant to, and compliant with these regulations, interested Tmesys network pharmacies should fill out the MAC Inquiry Form and Non-Disclosure Agreement that can be accessed via the Helios website and email the completed forms to MACresolution@helioscomp.com.

Thank you,

Tmesys

Effective January 1, 2016, CVS/caremark will begin to administer the prescription benefits for NSEBC. 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: RX0221

Member ID Format: 9 digits

Person Code : Not Required