Florida HealthEase Kids, a WellCare Health Plans company (the Plan), is making changes to the status of brand name Adderall XR® Capsules, as part of ongoing efforts to offer members access to quality, cost-effective health care. These changes are detailed in this notice.

Beginning April 1, 2015, Express Scripts will implement the Other Health Insurance (OHI) portion ONLY of the new DoD Tricare pharmacy benefit program. This enhancement allows our system to identify beneficiaries who have OHI.

Please note that in conjunction with this change, pharmacies may experience an increase in NCPDP Reject 41 (Submit Bill to Other Processor or Primary Payer) if a beneficiary has OHI but does not indicate it at point of sale.

The Centers for Medicare and Medicaid Services (CMS), through the Pharmacy Quality Alliance (PQA) and the American Geriatric Society, has identified certain medications that increase the risk for serious adverse events in patients 65 and older. To ensure the appropriate use of these potentially dangerous medications, Health Partners Medicare (HPM) has placed a prior authorization (PA) requirement on these medications for members 65 and older.

Below is a list of these medications and a safer alternative that does not require a PA. The full formularies, including prior authorization forms, can be found under the Prescription Drugs section of our website, http://medicare.healthpartnersplans.com/

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Express Scripts:  New Level of Effort Fee Structure