Effective March 1, 2015, retail workers’ compensation prescriptions for Tristar Risk Management injured workers receiving pharmacy care must be processed using the Tmesys retail pharmacy network from Helios™. Therefore, please accept this letter as notice that as of March 1, 2015 all Tristar Risk Management workers’ compensation pharmacy claims should be processed through Tmesys.

In an effort to support continued access to affordable prescription drug benefits, MedImpact Healthcare Systems, Inc., on behalf of participating plans, will preferentially cover the brand version of NEXIUM over generic ESOMEPRAZOLE MAGNESIUM when the generic becomes available in the market. Under this initiative, they are requesting pharmacies to dispense brand name NEXIUM for all new and refill ESOMEPRAZOLE MAGNESIUM prescriptions from 02/20/15 to 08/18/15 for members of participating plans. Pharmacies will continue to receive brand reimbursement for these fills.

Effective March 1, 2015 - Sunshine Health will be implementing drug restrictions on certain medications to enforce appropriate use and safety for our members. However, these restrictions can be overridden if the pharmacist and prescribing provider believe the member benefits from using the medication outside of our designated limitations.

Reminder:

APNS Pharmacy Providers are contracted for the following Aetna/Coventry networks:

MedImpact D.0 Payer Sheet – Commercial Processing

Publication Date: February 19, 2015