Cigna-HealthSpring currently utilizes a clinical program which is designed to review a member’s prescription history for possible drug related concerns. The goal is to improve the quality and cost effectiveness of dispensed medications by ensuring adjudicated prescriptions are clinically appropriate. The edits in place can be easily overridden by using the appropriate DUR/PPS Reason and Result codes found below. This edit assesses the total daily dose based on FDA approved maximum dosing information. The edit identifies single incoming claims of concern as well as overlapping claims with the member’s history based on specific ingredients. The edit will be triggered if the total daily dose exceeds the FDA-defined maximum daily dose.

© 2015 Express Scripts Holding Company. All Rights Reserved.

2/6/15

Effective January 1, 2015, Covered Persons of Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas will now experience higher co-pay or coinsurance costs with prescription claims for generic Concerta (Methylphenidate ER).  Please see the attachment below for further information.

The OptumRx 2015 Pharmacy Manual is now available on-line at http://learn.optumrx.com/pharmacymanual.

Prime Therapeutics LLC ("Prime") is partnering with Mirixa and OutcomesMTM to offer Medicare Part D Medication Therapy Management (MTM) services for certain Covered Persons in 2015.

If you would like more information about Mirixa or want to find out how to access Mirixa's free web-based MTM platform, MirixaPro SM, you can email support@mirixa.com, visit the website at http://www.mirixa.com/, or call 866.218.6649 (toll free). If you are already using the MirixaPro platform, you will have access to the Prime MTM program and there is no need to contact Mirixa.

If you would like more information about OutcomesMTM or want to find out how to access the OutcomesMTM free web-based MTM ConnectTM platform, please email info@outcomesmtm.com, visit the website at http://www.outcomesmtm.com/getting-started.aspx, or call 877.237.0050 (toll free). If you are already using the Connect platform, you will have access to the Prime MTM program.