APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

Size: px
Start display at page:

Download "APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1"

Transcription

1 APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2016

2 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2016 APPENDIX B: VENDOR DRUG PROGRAM Table of Contents B.1 Vendor Drug Program B.1.1 VDP Benefits for Medicaid Fee-for-Service (FFS) Clients B.1.2 Pharmacy Delivery Method for Clinician-Administered Drugs B.1.3 VDP Formulary Information B.1.4 Obtaining Outpatient Prescribed Drug Prior Authorization for FFS Clients B.1.5 Dispensing Life of Prescriptions B.1.6 Clinician-Administered Drugs B.1.7 VDP Contact Information B Hour Emergency Supply B.1.9 Cost Avoidance Coordination of Benefits B.1.10 Schedule II Controlled Substances (CII) through Schedule V Controlled Substances (CV) B.1.11 Tamper-Resistant Prescription Pads B.1.12 Requirements for Early Refills of Certain Drugs B.1.13 Free Delivery of Medicaid Prescriptions for FFS Clients B.1.14 Delivery of Medicaid Prescriptions for MCO Clients B.1.15 Pharmacies Can Dispense Home Health Supplies to Medicaid Clients B.1.16 Vitamin and Mineral Products B.2 Medicaid Children s Services Comprehensive Care Program (CCP) Available for Children and Adolescents B.3 Palivizumab (Synagis) Available Through the VDP B.3.1 Participating Palivizumab Distribution Pharmacies

3 B.1 Vendor Drug Program The Texas Medicaid Vendor Drug Program (VDP) makes payment for prescriptions of covered outpatient drugs to those pharmacy providers contracted with the VDP. In-state pharmacies licensed as Class A or C by the Texas State Board of Pharmacy are eligible for enrollment in the VDP. Out-of-state pharmacies and pharmacies holding any other class of pharmacy license are considered for inclusion in the program on a case-by-case basis, relative to the benefits made available to a client eligible for Texas Medicaid. Contracts are not granted to applicants unless additional benefits to the recipient are established. VDP provides statewide access to prescription drugs as prescribed by treating physician or other healthcare provider for clients eligible for: Medicaid fee-for-service Children with Special Health Care Needs (CSHCN) Services Program Kidney Health Care (KHC) Healthy Texas Women (HTW) program VDP manages drug formulary for Children s Health Insurance Program (CHIP). VDP remains responsible as claims processor for Medicaid fee-for-service (FFS) clients and management of Medicaid drug formulary and preferred drug list. Pharmacy services rendered to Medicaid managed care clients are administered by the clients managed care organizations (MCOs). The Medicaid Managed Care Handbook (Vol. 2, Provider Handbooks) for additional information about managed care prescription drug and pharmacy benefits. B.1.1 VDP Benefits for Medicaid Fee-for-Service (FFS) Clients The Medicaid drug benefit for Medicaid FFS clients is limited to three prescriptions per month with the following exceptions that have unlimited prescriptions: Clients enrolled in waiver programs such as Community Living Assistance (CLASS) and Community-Based Alternatives (CBA) Texas Health Steps (THSteps)-eligible clients (clients who are 20 years of age and younger) Clients in skilled nursing facilities The following categories of drugs do not count against the three prescription per month limit: Family planning drugs and supplies Smoking cessation drugs Insulin syringes Prescriptions for family planning drugs and limited home health supplies are not subject to the three-prescription limit. Though TMHP reimburses family planning agencies and physicians for family planning drugs and supplies, the following family planning drugs and supplies are also available through the VDP and are not subject to the three-prescription limit: Oral contraceptives Long-acting injectable contraceptives Vaginal ring Hormone patch 3

4 Certain drugs used to treat sexually transmitted diseases (STDs) The Product Search on the VDP website at for more information. FFS clients can be locked-in to a specific pharmacy. FFS clients who are locked-in to a primary care pharmacy have Lock-in printed on their Your Texas Benefits Medicaid card. Clients who are not locked-in to a specific pharmacy may obtain their drugs or supplies from any contracted Medicaid provider of pharmaceutical services. Subsection 4.4.2, Client Lock-in Program in Section 4: Client Eligibility (Vol. 1, General Information) for more information about lock-in limitations. Family planning services are excluded from lock-in limitation. The VDP does not reimburse claims for nutritional products (enteral or parenteral), medical supplies, or equipment other than limited home health supplies. B.1.2 Pharmacy Delivery Method for Clinician-Administered Drugs Providers administering clinician-administered drugs in an outpatient setting for Medicaid fee-forservice (FFS) and Medicaid Managed Care Organization (MCO) clients can send a prescription to a pharmacy and wait for the drug to be shipped or mailed to their office. This delivery method is called white-bagging. Providers should use the following steps for this delivery method: 1) The treating provider identifies a Medicaid-enrolled client. 2) The treating provider or treating provider s agent sends a prescription to a Texas Medicaid-enrolled pharmacy and obtains any necessary prior authorizations. 3) If any prior authorization is approved, the dispensing pharmacy fills the prescription and overnight ships an individual dose of the medication, in the name of the Medicaid client, directly to the treating provider. 4) The treating provider administers the medication to the Medicaid client in the office setting. The provider bills for an administration fee and any medically necessary service provided at time of administration. The provider should not bill Medicaid for the drug. The pharmacy contacts the provider each month, prior to dispensing any refills, to ensure that the patient was administered all previously dispensed medication. Auto-refills are not allowed. These medications cannot be used on any other patient and cannot be returned to the pharmacy for credit. Exception: Unused long-acting reversible contraceptives may be returned in certain circumstances. Physicians who use this delivery method will not have to buy the clinician-administered drug, therefore, the physician is allowed to administer the drug and should only bill for the administration of the drug. B.1.3 VDP Formulary Information VDP drug formulary information is available to health-care providers to help their clients efficiently get their medications. Information includes which state health-care program covers the drug, whether a drug is on the Medicaid Preferred Drug List (PDL), whether a Medicaid non-preferred prior authorization or clinical prior authorization is required, and other important drug information. VDP drug formulary information is available: Online at (All state health-care program formulary information with prior authorization type (PDL or clinical) required indicator) 4

5 Online at Here providers can find Medicaid drug formulary and PDL information with links attached to selected non-preferred drugs that will guide providers to the preferred drugs in that therapeutic class. Providers are eligible to register for Epocrates, which is a free drug information service that can be downloaded to the provider s mobile device. In addition to listing a drug s preferred status, Epocrates includes drug monographs, dosing information, and warnings. For more information, go to B.1.4 Obtaining Outpatient Prescribed Drug Prior Authorization for FFS Clients To obtain prior authorization for any VDP medication for FFS clients, prescribing providers or their representatives should call the Texas Prior Authorization Hotline at PA-TEXAS ( ). The Hotline is available Monday through Friday, 7:30 a.m. to 6:30 p.m. Central Time. To submit an online VDP prior authorization request for non-preferred drugs, prescribing providers must first register online at For Synagis prior authorization, see subsection B.3, Palivizumab (Synagis) Available Through the VDP in this section. Pharmacists cannot obtain prior authorization for medications. If the client arrives at the pharmacy without prior authorization for a non-preferred drug, the pharmacist will alert the provider s office and ask the provider to get prior authorization. B.1.5 Dispensing Life of Prescriptions Medicaid prescriptions for noncontrolled substances are valid for one year from the date written and up to 11 refills if authorized by prescriber. Medicaid prescriptions for controlled substances in drug classes C3-C5 are valid for six months from the date written and up to 5 refills if authorized by prescriber provider. Controlled substance prescriptions written by Advanced Practice Registered Nurses and Physicians Assistants are valid for 90 days. Medicaid prescriptions controlled substances in C2 drug class have no refills and must be dispensed within 21 days of the date on which the prescription was written. CII prescriptions may be written as multiples of three for a total of a 90 day supply subject to federal and state law. VDP Pharmacy Provider Procedure Manual at Texas State Board of Pharmacy website at for rules about issuance of identical sets of C2 prescriptions. B.1.6 Clinician-Administered Drugs All Texas Medicaid providers must submit a rebateable NDC for professional or outpatient claims submitted to TMHP with a clinician-administered drug procedure code. The NDC is an 11-digit number on the package or container from which the medication is administered. Providers must enter identifier N4 before the NDC code. The NDC unit and the NDC unit of measure must be entered on all professional or outpatient claims that are submitted to TMHP and Medicaid managed care plans. A list of drugs that require an NDC for Texas Medicaid reimbursement is available on the TMHP website at under the Topics section. Clinician-administered drugs that do not have a rebateable NDC will not be reimbursed by Texas Medicaid. Subsection 6.3.4, National Drug Code (NDC) in Section 6: Claims Filing (Vol. 1, General Information) for additional information on claims filing using NDC. 5

6 B.1.7 VDP Contact Information Vendor Drug Program Pharmacy Benefits Access: for questions about outpatient drug and billing (the 800 number is for pharmacy use only and can be used to reach anyone in VDP). B Hour Emergency Supply Federal and Texas law allows for a 72-hour emergency supply of a prescribed drug to be provided when a medication is needed without delay and prior authorization is not available. This rule applies to nonpreferred drugs on the Preferred Drug List (PDL) and any drug that is affected by a clinical prior authorization criteria and needs the prescriber s prior approval. Some preferred drugs on the Medicaid formulary may also be subject to clinical criteria that require additional prior authorization. Drugs not on the PDL may also be subject to clinical prior authorization criteria. VDP Pharmacy Provider Procedure Manual at B.1.9 Cost Avoidance Coordination of Benefits Cost avoidance coordination of benefits (COB) for pharmacy claims ensures compliance with the Centers for Medicare & Medicaid Services (CMS) regulations. Under federal rules, Medicaid agencies must be the payer of last resort. The cost avoidance model checks for other known insurance at the point of sale, preventing Medicaid from paying a claim until the pharmacy attempts to obtain payment from the client s third party insurance. VDP Pharmacy Provider Procedure Manual at B.1.10 Schedule II Controlled Substances (CII) through Schedule V Controlled Substances (CV) Pharmacies must report all CIII, CIV, and CV prescriptions to the Texas Department of Public Safety (DPS) in addition to the CII prescriptions that are already being reported. This DPS process requires reporting by the DPS registration number of the practitioner issuing the prescription. The prescription forms for Schedule CII controlled substances that are issued by the Texas Department of Public Safety (DPS) under the Texas Prescription Program meet the baseline standards set forth above. The DPS website at B.1.11 Tamper-Resistant Prescription Pads Telephone Number Pharmacy enrollment Program management Policy Drug formulary (Texas listing of national drug codes) Texas Prior Authorization Center Hotline Providers are required by federal law (Public Law ) to use a tamper-resistant prescription pad when writing a prescription for any drug for Medicaid clients. Pharmacies are required to ensure that all written Medicaid prescriptions submitted for payment to the VDP were written on a compliant tamper resistant pad. CMS has stated that special copy-resistant paper is not a requirement for electronic medical records (EMRs) or eprescribing-generated prescriptions and prescriptions that are faxed directly to the pharmacy. These prescriptions may be printed on plain paper and will be fully compliant if they contain at least one feature from each of the following three categories: Prevents unauthorized copying of completed or blank prescription forms Prevents erasure or modification of information written on the prescription form 6

7 Prevents the use of counterfeit prescription forms Two features that can be incorporated into computer-generated prescriptions printed on plain paper to prevent passing a copied prescription as an original prescription are as follows: Use a very small font that is readable when viewed at 5x magnification or greater and illegible when copied. Use a void pantograph accompanied by a reverse Rx, which causes a word such as Void to appear when the prescription is photocopied. VDP Pharmacy Provider Procedure Manual B.1.12 Requirements for Early Refills of Certain Drugs Medicaid fee-for-service and the Children with Special Health Care Needs (CSHCN) Services Program clients must exhaust 90 percent of the prescribed of certain controlled substances, including tramadol, before a Medicaid Vendor Drug Program (VDP)- enrolled pharmacy may refill a prescription or fill a new prescription for the same drug. Some drugs, such as attention deficit hyperactivity disorder drugs and certain seizure medications, are excluded from this change. The 90% Utilization Drug List, which contains a complete list of the affected drugs, is available on the Vendor Drug Program s formulary lookup by selecting the 90% Utilization indicator on the drug list lookup and the returned results will include only those drugs that meet this requirement. Justifications for early refills include, but are not limited to, the following: A verifiable dosage increase An anticipated prolonged absence from the state If a client requests an early refill of a drug on the VDP list, the dispensing pharmacy must contact the VDP Pharmacy Resolution help desk to request an override of the early refill restriction. Prescribing providers may be asked to verify the reason for the early refill by the dispensing pharmacy or VDP staff. B.1.13 Providers who are members of Medicaid managed care plans should contact the appropriate managed care organization (MCO) and/or Pharmacy Benefit Manager for specific requirements and processes related to dispensing early refills. Free Delivery of Medicaid Prescriptions for FFS Clients Many Medicaid pharmacies across the state offer free delivery of prescriptions to Medicaid FFS clients. To find out which pharmacies offer home delivery, refer FFS clients to the Vendor Drug Program s pharmacy provider lookup. Click the Delivers indicator on the lookup and the returned results will include only those pharmacies that provide a delivery service to Medicaid clients. Contracted Medicaid pharmacy providers are reimbursed a delivery fee that is included in the medication dispensing fee formula. The delivery fee is paid to HHSC-approved pharmacy providers that have certified that delivery services meet minimum conditions for payment of the delivery fee. The conditions include: Making deliveries to individuals rather than to institutions, such as nursing homes. Offering no-charge prescription delivery to all Medicaid clients who request it in the same manner as to the general public. Displaying publicly the availability of prescription delivery services at no charge in a prominent place in the pharmacy store (window or door). Providing the delivery service without requiring retention of the Your Texas Benefits Medicaid card. 7

8 This delivery fee is not applicable for mail-order prescriptions and not available for over-the-counter drugs. For more information, call the Vendor Drug Pharmacy Benefits Access Help Desk at and ask for Pharmacy Contracts. B.1.14 Delivery of Medicaid Prescriptions for MCO Clients Medicaid and CHIP MCOs pay local pharmacies to deliver pharmaceuticals to clients. Each MCO develops its own participating pharmacy network for this delivery service. Pharmacies that are interested in receiving payment for the delivery of pharmaceuticals to MCO clients should contact their MCOs to request information on how to apply. The VDP website at has several managed care resources: The Pharmacy Enrollment Chart at includes the pharmacy contract telephone number for each MCO. The Prescriber Assistance Chart at includes the pharmacy prior authorization call center telephone numbers for each health plan. B.1.15 Pharmacies Can Dispense Home Health Supplies to Medicaid Clients Pharmacies that are enrolled with VDP can dispense a limited set of home health supplies that are commonly found in a pharmacy to fee-for-service Medicaid clients. Pharmacies can also dispense home health supplies to clients who are enrolled in a Medicaid MCO if the pharmacy is enrolled in the client s MCO. The list of home health supplies that can be dispensed at a pharmacy can be found in the Home Health Supplies chapter of the VDP Pharmacy Provider Procedure Manual. More information about the provision of these supplies through a fee-for-service pharmacy can be found on the VDP website at Providers should contact the appropriate MCO or pharmacy benefit manager for more information about providing these supplies to Medicaid clients who are enrolled in a Medicaid managed care plan. B.1.16 Vitamin and Mineral Products Pharmacies that are contracted with VDP can dispense some vitamin and mineral products to Texas Medicaid fee-for-service clients who are 20 years of age and younger. Pharmacies can also dispense these covered vitamin and minerals products to clients who are enrolled in a Medicaid MCO, if the pharmacy is enrolled in client s MCO. VDP-contracted pharmacies can honor a physician s prescription for covered vitamins and minerals. To help expedite pharmacy claim processing, prescribing providers are encouraged to include the diagnosis on the prescription. VDP-contracted pharmacies are required to be enrolled with TMHP and have a CCP Prior Authorization Request Form to dispense a prescription for vitamins and minerals if they intend to submit the claim to TMHP as a medical benefit instead of billing as a pharmacy benefit through VDP. VDP-contracted pharmacies that are not enrolled with TMHP may submit claims for vitamin or mineral products to VDP. The list of home health supplies that can be dispensed at a pharmacy can be found in the Vitamin and Mineral Products chapter of the VDP Pharmacy Provider Procedure Manual. More information about the provision of these products and list of products for fee-for-service clients can be found on the VDP website at 8

9 B.2 Medicaid Children s Services Comprehensive Care Program (CCP) Available for Children and Adolescents Medically necessary drugs and supplies that are not covered by the VDP may be available to children and adolescents (birth through 20 years of age) through the CCP (i.e., some over the counter drugs, nutritional products, diapers, and disposable or expendable medical supplies). The Prior Authorization fax number is Subsection , Pharmacies (CCP) in the Children s Services Handbook (Vol. 2, Provider Handbooks) for more information about pharmacy enrollment in CCP. B.3 Palivizumab (Synagis) Available Through the VDP Palivizumab is available to physicians for administering to Medicaid clients only through the VDP. This option enables physicians to have palivizumab shipped directly to their office from a network pharmacy. Physicians will not need to purchase the drug. Physicians who obtain palivizumab through the VDP may not submit claims to Medicaid (TMHP) for the drug. The administering provider may submit a claim to TMHP for an injection administration fee and any medically necessary office-based evaluation and management service provided at time of injection. For more information, including the current season s schedule and a list of participating pharmacies, refer to the HHSC Vendor Drug Synagis Program page at B.3.1 Participating Palivizumab Distribution Pharmacies For a list of participating pharmacies, refer to the HHSC Vendor Drug website at Palivizumab forms are updated every year. Providers must use the most current version of the forms to submit prior authorization requests. The Texas Medicaid/CHIP Vendor Drug Program Fee-For-Service Medicaid Synagis Request Form for Season is required when the prescribing provider obtains the drug through VDP. Palivizumab is also be available to Children with Special Health Care Needs (CSHCN) Services Program clients. Providers can refer to the CSHCN Services Program Provider Manual for details. Texas Medicaid/CHIP Vendor Drug Program Fee-For-Service Medicaid Synagis Request Form on the VDP website. 9

APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2015 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2015 APPENDIX B: VENDOR DRUG PROGRAM Table of

More information

APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 APPENDIX B: VENDOR DRUG PROGRAM TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 APRIL 2018 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 APRIL 2018 APPENDIX B: VENDOR DRUG PROGRAM Table of Contents

More information

Texas Vendor Drug Program Pharmacy Provider Procedure Manual

Texas Vendor Drug Program Pharmacy Provider Procedure Manual Texas Vendor Drug Program Pharmacy Provider Procedure Manual About the Vendor Drug Program May 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.

More information

Texas Vendor Drug Program Pharmacy Provider Procedure Manual

Texas Vendor Drug Program Pharmacy Provider Procedure Manual Texas Vendor Drug Program Pharmacy Provider Procedure Manual System Requirements May 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual. ` Table

More information

Texas Vendor Drug Program. Pharmacy Provider Procedure Manual Coordination of Benefits. Effective Date. February 2018

Texas Vendor Drug Program. Pharmacy Provider Procedure Manual Coordination of Benefits. Effective Date. February 2018 Texas Vendor Drug Program Pharmacy Provider Procedure Manual Coordination of Benefits Effective Date February 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.

More information

Table of Contents. Texas Vendor Drug Program Overview Requirements Envolve Communication Notices...

Table of Contents. Texas Vendor Drug Program Overview Requirements Envolve Communication Notices... Superior HealthPlan Table of Contents Texas Vendor Drug Program Overview 5 Requirements 6 Envolve Communication Notices.... 7-11 Superior HealthPlan Overview..14-23 Benefit Design.. 24 Envolve Pharmacy

More information

Florida Medicaid. Prescribed Drugs Services Coverage Policy. Agency for Health Care Administration. Draft Rule

Florida Medicaid. Prescribed Drugs Services Coverage Policy. Agency for Health Care Administration. Draft Rule Florida Medicaid Prescribed Drugs Services Coverage Policy Agency for Health Care Administration Draft Rule Table of Contents Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions...

More information

Texas Vendor Drug Program. Drug Addition Process. Effective Date. December 2017

Texas Vendor Drug Program. Drug Addition Process. Effective Date. December 2017 Texas Vendor Drug Program Drug Addition Process Effective Date December 2017 This is a working document to provide a resource to interested internal and external stakeholders. Questions or comments regarding

More information

Get the most from your

Get the most from your Get the most from your FOREIGN SERVICE BENEFIT PLAN (FSBP) Welcome to Express Scripts What s Inside Your benefit at a glance...2 FSBP s preferred medicines...2 Coverage limits...3 Home delivery overseas...5

More information

Prescription Drug Benefits

Prescription Drug Benefits Stryker s healthcare plan provides benefits for covered prescription drugs, including contraceptives, insulin and diabetic supplies. Benefits are paid for covered drugs that are medically necessary for

More information

See Medical Benefit Summary See Medical Benefit Summary

See Medical Benefit Summary See Medical Benefit Summary Benefit Summary Outpatient Prescription Drug Products Oregon Plan I1 Standard Drugs: 15/30/50 Your Co-payment and/or Co-insurance is determined by the tier to which the Prescription Drug List (PDL) Management

More information

See Medical Benefit Summary. See Medical Benefit Summary

See Medical Benefit Summary. See Medical Benefit Summary YOUR BENEFITS Benefit Summary Outpatient Prescription Drug Copper PPO Pharmacy Plan Standard Retail Network With CVS This document is provided as a sample and does not reflect actual benefits. A customized

More information

CERTIFIED RESPIRATORY CARE PRACTITIONER (CRCP) CSHCN SERVICES PROGRAM PROVIDER MANUAL

CERTIFIED RESPIRATORY CARE PRACTITIONER (CRCP) CSHCN SERVICES PROGRAM PROVIDER MANUAL CERTIFIED RESPIRATORY CARE PRACTITIONER (CRCP) CSHCN SERVICES PROGRAM PROVIDER MANUAL SEPTEMBER 2018 CSHCN PROVIDER PROCEDURES MANUAL SEPTEMBER 2018 CERTIFIED RESPIRATORY CARE PRACTITIONER (CRCP) Table

More information

Prescription Drug Benefits

Prescription Drug Benefits Stryker s healthcare plan provides benefits for covered prescription drugs, including contraceptives, insulin and diabetic supplies. Benefits are paid for covered drugs that are medically necessary for

More information

Contents General Information General Information

Contents General Information General Information Contents General Information... 1 Preferred Drug List... 2 Pharmacies... 3 Prescriptions... 4 Generic and Preferred Drugs... 5 Express Scripts Website and Mobile App... 5 Specialty Medicines... 5 Prior

More information

Prescription Drug Coverage

Prescription Drug Coverage The Company s medical plans automatically include coverage for prescription drugs which is administered by Envision Pharmaceutical Services, Inc. (Envision Rx) for prescriptions filled at retail pharmacies

More information

Oklahoma Health Care Authority

Oklahoma Health Care Authority Oklahoma Health Care Authority It is very important that you provide your comments regarding the proposed rule change by the comment due date. Comments are directed to Oklahoma Health Care Authority (OHCA)

More information

Get the most from your prescription benefit

Get the most from your prescription benefit Get the most from your prescription benefit TE Connectivity HealthFund HRA Plan Welcome to Express Scripts What s Inside Your benefit at a glance...2 Your plan s preferred medicines...2 Prior authorization...2

More information

PHARMACY GENERAL INFORMATION

PHARMACY GENERAL INFORMATION Pharmacy Program Cenpatico Integrated Care (Cenpatico IC) is committed to providing appropriate high quality and cost-effective medication therapy to all Cenpatico IC members. Cenpatico IC works with providers

More information

Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - Pharmacy

Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - Pharmacy Blue Essentials, Blue Advantage HMO SM and Blue Premier SM Provider Manual - In this Section there are references unique to Blue Essentials, Blue Advantage HMO and Blue Premier. These network specific

More information

PHYSICIAN ASSISTANT (PA) CSHCN SERVICES PROGRAM PROVIDER MANUAL

PHYSICIAN ASSISTANT (PA) CSHCN SERVICES PROGRAM PROVIDER MANUAL PHYSICIAN ASSISTANT (PA) CSHCN SERVICES PROGRAM PROVIDER MANUAL OCTOBER 2018 CSHCN PROVIDER PROCEDURES MANUAL OCTOBER 2018 PHYSICIAN ASSISTANT (PA) Table of Contents 32.1 Enrollment......................................................................

More information

Chapter 21. Pharmacy Services

Chapter 21. Pharmacy Services Last Updated: 11/14/2018 1:52:00 PM Chapter 21 Pharmacy Services Definitions Compounded Prescription: A prescription prepared in accordance with Minnesota Rules 6800.3100. Dispensing Date: The actual date

More information

See Medical Benefit Summary See Medical Benefit Summary

See Medical Benefit Summary See Medical Benefit Summary Benefit Summary Outpatient Prescription Drug Products Illinois Plan MM Standard Drugs: 0/0/0 Your Co-payment and/or Co-insurance is determined by the tier to which the Prescription Drug List (PDL) Management

More information

See Medical Benefit Summary See Medical Benefit Summary. See Medical Benefit Summary See Medical Benefit Summary

See Medical Benefit Summary See Medical Benefit Summary. See Medical Benefit Summary See Medical Benefit Summary Benefit Summary Outpatient Prescription Drug Missouri 10/35/60 Plan 2V Your Co-payment and/or Co-insurance is determined by the tier to which the Prescription Drug List (PDL) Management Committee has assigned

More information

Benefit Summary. Outpatient Prescription Drug Products Virginia Plan 2V Standard Drugs: 10/35/60. Annual Drug Deductible - Network and Out-of-Network

Benefit Summary. Outpatient Prescription Drug Products Virginia Plan 2V Standard Drugs: 10/35/60. Annual Drug Deductible - Network and Out-of-Network Benefit Summary Outpatient Prescription Drug Products Virginia Plan 2V Standard Drugs: 10/35/60 Your Co-payment and/or Co-insurance is determined by the tier to which the Prescription Drug List (PDL) Management

More information

Texas Vendor Drug Program. Pharmacy Provider Procedure Manual. Managed Care. Effective Date. November 2017

Texas Vendor Drug Program. Pharmacy Provider Procedure Manual. Managed Care. Effective Date. November 2017 Texas Vendor Drug Program Pharmacy Provider Procedure Manual Managed Care Effective Date November 2017 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.

More information

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Certified Respiratory Care Practitioner (CRCP) Services Handbook

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Certified Respiratory Care Practitioner (CRCP) Services Handbook Texas Medicaid Provider Procedures Manual Provider Handbooks October 2018 Certified Respiratory Care Practitioner (CRCP) Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims

More information

Classification: Clinical Department Policy Number: Subject: Medicare Part D General Transition

Classification: Clinical Department Policy Number: Subject: Medicare Part D General Transition Classification: Clinical Department Policy Number: 3404.00 Subject: Medicare Part D General Transition Effective Date: 01/01/2019 Process Date Revised: 07/20/2018 Date Reviewed: 05/29/2018 POLICY STATEMENT:

More information

1 INSURANCE SECTION Instructions: This section contains information about the cardholder and their plan identification.

1 INSURANCE SECTION Instructions: This section contains information about the cardholder and their plan identification. 1 INSURANCE SECTION : This section contains information about the cardholder and their plan identification. 1 ID of Cardholder Required. Enter the recipient s 13 digit Medicaid ID. 2 Group ID Not Required.

More information

PHARMACY BENEFIT MEMBER BOOKLET

PHARMACY BENEFIT MEMBER BOOKLET PHARMACY BENEFIT MEMBER BOOKLET Printed on: VALUE, QUALITY AND CONFIDENCE Costco Health Solutions Customer Care HOURS: 24 Hours a Day 7 Days a Week (877) 908-6024 (toll-free) TTY 711 MAILING ADDRESS: Costco

More information

Value Three-Tier EFFECTIVE DATE: 01/01/2016 FORM #1779_03

Value Three-Tier EFFECTIVE DATE: 01/01/2016 FORM #1779_03 Value Three-Tier This brochure is a legal document that explains the prescription drug benefits provided by Harvard Pilgrim Health Care, Inc. (HPHC) to Members with plans that include outpatient pharmacy

More information

See Medical Benefit Summary See Medical Benefit Summary. See Medical Benefit Summary See Medical Benefit Summary. Up to 31-day supply

See Medical Benefit Summary See Medical Benefit Summary. See Medical Benefit Summary See Medical Benefit Summary. Up to 31-day supply YOUR BENEFITS Benefit Summary Outpatient Prescription Drug Keller ISD High Deductible 2019 Pharmacy Plan This document is provided as a sample and does not reflect actual benefits. A customized Benefit

More information

We applied the following methodology and assumptions changes to our original estimates:

We applied the following methodology and assumptions changes to our original estimates: 333 Clay Street Suite 4330 Houston, TX 77002 USA Tel +1 713 658 8451 Fax +1 713 658 9656 April 1, 2013 milliman.com Ms. Barbara Maxwell Deputy Director Texas Association of Health Plans 1001 Congress Avenue,

More information

Prescription Drug Brochure

Prescription Drug Brochure Value Five-Tier Prescription Drug Brochure This brochure is a legal document that explains the prescription drug benefits provided by Harvard Pilgrim Health Care, Inc. (HPHC) to Members with plans that

More information

Indiana Health Coverage Program Seminar Presented by MDwise Pharmacy October 22-24, 2007 P0153 (9/07)

Indiana Health Coverage Program Seminar Presented by MDwise Pharmacy October 22-24, 2007 P0153 (9/07) Indiana Health Coverage Program Seminar Presented by MDwise Pharmacy October 22-24, 2007 P0153 (9/07) Overview Pharmacy Benefit Manager Pharmacy Claims Processor Preferred Drug List Pharmacist Override

More information

Overview of the BCBSRI Prescription Management Program

Overview of the BCBSRI Prescription Management Program Overview of the BCBSRI Prescription Management Program A. Prescription Drugs Dispensed at a Pharmacy This plan covers prescription drugs listed on the Blue Cross & Blue Shield RI (BCBSRI) formulary and

More information

Health Net Health Plan of Oregon, Inc. BeneFacts: Family PPO Crystal High Deductible Health Plan Copayment and Coinsurance Schedule FHDHP10000/08

Health Net Health Plan of Oregon, Inc. BeneFacts: Family PPO Crystal High Deductible Health Plan Copayment and Coinsurance Schedule FHDHP10000/08 BeneFacts: Family PPO Crystal High Deductible Health Plan Copayment and Coinsurance Schedule FHDHP10000/08 PPO: Two plans, many choices. PPO stands for Preferred Provider Organization. For you, PPO means

More information

Provider Manual. Section 10: Pharmacy

Provider Manual. Section 10: Pharmacy Provider Manual Section 10: Pharmacy Table of Contents SECTION 10: PHARMACY SERVICES... 3 10.1 PHARMACY FORMULARY... 3 10.2 FORMULARY ACCESS... 4 10.2.1 How to Use the Lexicomp Online Formulary... 5 10.3

More information

SECTION 8: THIRD PARTY LIABILITY (TPL) TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

SECTION 8: THIRD PARTY LIABILITY (TPL) TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 SECTION 8: THIRD PARTY LIABILITY (TPL) TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 FEBRUARY 2018 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 FEBRUARY 2018 SECTION 8: THIRD PARTY LIABILITY (TPL)

More information

Pharmacy Provider Enrollment Application

Pharmacy Provider Enrollment Application 1. Application Date 11/28/2018 New Pharmacy Re-enrollment Vendor # 2. Applicant Name Of Pharmacy (Doing Business As) ABC Pharmacy Legal contractor name ABC Pharmacy, Inc Telephone Fax Email Change of Ownership

More information

Provider Manual Amendments

Provider Manual Amendments Amendments L.A. Care Health Plan Revised 11/2015 lacare.org LA1478 11/15 16.0 Pharmacy Overview L.A. Care s prescription drug formulary is designed to support the achievement of positive member health

More information

Prescription Benefits State of Maryland. CVS Caremark manages your prescription drug benefit under a contract with the State of Maryland.

Prescription Benefits State of Maryland. CVS Caremark manages your prescription drug benefit under a contract with the State of Maryland. Prescription Benefits State of Maryland CVS Caremark manages your prescription drug benefit under a contract with the State of Maryland. Introduction This Prescription Benefit document describes how to

More information

Prescription Drug Rider

Prescription Drug Rider Prescription Drug Rider Rx Member Cost-Sharing: $10/$25/$40/$40 According to this prescription drug program, you may receive coverage for prescription drugs in the amounts specified in your rider when

More information

Webinar Schedule Join us for our next webinar! Are you a newly contracted Provider? Existing Provider who has new staff? Would your office like to lea

Webinar Schedule Join us for our next webinar! Are you a newly contracted Provider? Existing Provider who has new staff? Would your office like to lea Fall 2018 Provider Newsletter What s New? Provider Services Phone Number 888-243-3312 We are excited to share a change with you! Our dedicated Provider Services telephone number launched on November 1

More information

21 - Pharmacy Services

21 - Pharmacy Services 21 - Pharmacy Services The role of Health Plan of Nevada s (HPN) Pharmacy Services is to evaluate and determine the appropriateness of quality drug therapy while maintaining and improving therapeutic outcomes.

More information

10.1 Summary Prescription drug coverage for you and your eligible Dependents Three-tier Copayment plan Retail and maintenance programs

10.1 Summary Prescription drug coverage for you and your eligible Dependents Three-tier Copayment plan Retail and maintenance programs 10.1 Summary Prescription drug coverage for you and your eligible Dependents Three-tier Copayment plan Retail and maintenance programs Through the Prescription Drug Plan, you and your eligible Dependents

More information

Provider Manual Section 12.0 Outpatient Pharmacy Services

Provider Manual Section 12.0 Outpatient Pharmacy Services Provider Manual Section 12.0 Outpatient Pharmacy Services Table of Contents 12.1 Prescribing Outpatient Medications for Enrollees 12.2 Prescription Medications & Prior Authorization 12.3 Pharmacy Lock-In

More information

Florida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter July 1, 2016 through September 30, 2016

Florida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter July 1, 2016 through September 30, 2016 Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarter July 1, through September 30, Report to the Florida Legislature March 2018 [This page intentionally left blank.] Table

More information

The Health Plan has processes in place that explain how members, pharmacists, and physicians:

The Health Plan has processes in place that explain how members, pharmacists, and physicians: Introduction Overview The Health Plan shall promote optimal therapeutic use of pharmaceuticals by encouraging the use of cost effective generic and/or brand drugs in certain therapeutic classes. The Health

More information

Prescription Medication Schedule of Benefits

Prescription Medication Schedule of Benefits Prescription Medication Schedule of Benefits Rx Member Cost-Sharing: $15/$35/$70/$70 When you go to a pharmacy that participates in the UPMC Health Plan pharmacy network, you will be able to receive coverage

More information

Prescription Drug Schedule of Benefits

Prescription Drug Schedule of Benefits Prescription Drug Schedule of Benefits Rx Member Cost-Sharing: $5/$15/$35/$35 When you go to a pharmacy that participates in the UPMC Health Plan pharmacy network, you will be able to receive coverage

More information

Provider Manual. Section 10: Pharmacy

Provider Manual. Section 10: Pharmacy Provider Manual Section 10: Pharmacy Table of Contents SECTION 10: PHARMACY SERVICES... 3 10.1 PHARMACY FORMULARY... 3 10.2 FORMULARY ACCESS... 4 10.2.1 How to Use the Lexicomp Online Formulary... 5 10.3

More information

POLICY STATEMENT: PROCEDURE:

POLICY STATEMENT: PROCEDURE: PAGE 1 OF 12 POLICY STATEMENT: NPS shall provide an automated process to assist beneficiaries who are transitioning from drug regimens or therapies that are not covered on the Part D Plan S are on the

More information

Outpatient Prescription Drug Benefits

Outpatient Prescription Drug Benefits Outpatient Prescription Drug Benefits Supplement to Your HMO/POS Evidence of Coverage Summary of Benefits Member Calendar Year Brand Drug Deductible Per Member Applicable to all covered Brand Drugs, including

More information

Subject: Pharmacy Services & Formulary Management (Page 1 of 5)

Subject: Pharmacy Services & Formulary Management (Page 1 of 5) Subject: Pharmacy Services & Formulary Management (Page 1 of 5) Objective: I. To ensure the clinically appropriate prescription and use of pharmaceuticals by Tuality Health Alliance (THA) providers and

More information

SBCFF Modified Rx 10/30/45 Prescription Drug Benefits

SBCFF Modified Rx 10/30/45 Prescription Drug Benefits Rx Benefits SBCFF Modified Rx 10/30/45 Prescription Drug Benefits This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently

More information

Primary Choice Plan Premium Three-Tier

Primary Choice Plan Premium Three-Tier Primary Choice Plan Premium Three-Tier This brochure is a legal document that explains the prescription drug benefits provided by the Group Insurance Commission (GIC) to their Members on a self-insured

More information

BlueRx PDP. Link to Specific Guidance Regarding Exceptions and Appeals

BlueRx PDP. Link to Specific Guidance Regarding Exceptions and Appeals BlueRx PDP Conditions and Limitations Potential for Contract Termination Disenrollment Rights and Instructions Exceptions, Prior Authorization, Appeals and Grievances Out-of-Network Coverage Quality Assurance

More information

Blue Shield of California Life & Health Insurance Company

Blue Shield of California Life & Health Insurance Company Blue Shield of California Life & Health Insurance Company Outpatient Prescription Drug Benefit Rider Insurance Certificate Outpatient Prescription Drug Benefit Summary of Benefits Insured Calendar Year

More information

Iowa Medicaid Synopsis of Managed Medicaid Request for Proposal

Iowa Medicaid Synopsis of Managed Medicaid Request for Proposal Iowa Medicaid Synopsis of Managed Medicaid Request for Proposal The following information provides summary information of key aspects of the Iowa Medicaid Request For Proposal SOW for Capitated Managed

More information

Florida Medicaid Prescribed Drug Service Spending Control Initiatives

Florida Medicaid Prescribed Drug Service Spending Control Initiatives Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarters January 1, through March 31, and April 1, through June 30, Report to the Florida Legislature April 2018 [This page

More information

Kroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description

Kroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description Kroll Ontrack, LLC Prescription Drug Plan Plan Document and Summary Plan Description Effective December 9, 2016 Kroll Ontrack, LLC reserves the right to amend the Kroll Ontrack, LLC Health & Welfare Plan

More information

Sharp Health Plan Outpatient Prescription Drug Benefit

Sharp Health Plan Outpatient Prescription Drug Benefit Sharp Health Plan Outpatient Prescription Drug Benefit GENERAL INFORMATION This supplemental Evidence of Coverage and Disclosure Form is provided in addition to your Member Handbook and Health Plan Benefits

More information

Medicaid Prescribed Drug Program Spending Control Initiatives. For the Quarter April 1, 2014 through June 30, 2014

Medicaid Prescribed Drug Program Spending Control Initiatives. For the Quarter April 1, 2014 through June 30, 2014 Medicaid Prescribed Drug Program Spending Control Initiatives For the Quarter April 1, 2014 through June 30, 2014 Report to the Florida Legislature January 2015 Table of Contents Purpose of Report... 1

More information

Prescription Medication Rider

Prescription Medication Rider Prescription Medication Rider Rx Member Cost-Sharing: $16/$40/$80/$90 According to this prescription medication program, you may receive coverage for prescription medications in the amounts specified in

More information

Excellus BlueCross BlueShield Participating Provider Manual. 5.0 Pharmacy Management

Excellus BlueCross BlueShield Participating Provider Manual. 5.0 Pharmacy Management Excellus BlueCross BlueShield Participating Provider Manual 5.0 Pharmacy Management 5.1 Pharmacy Benefits The Health Plan is committed to effectively managing prescription drug benefit costs and providing

More information

MEDICARE PART D POLICY FORMULARY: TRANSITION PROCESS Policy Number: 6-C

MEDICARE PART D POLICY FORMULARY: TRANSITION PROCESS Policy Number: 6-C MEDICARE PART D POLICY FORMULARY: TRANSITION PROCESS Policy Number: 6-C Coverage Statement This Policy is applicable to: Medco PDP, Beneficiaries, Enhanced PDPs, Client PDPs and Client MA-PDs, to the extent

More information

HSA Prescription Benefit Plan Summary

HSA Prescription Benefit Plan Summary Getting Started Access your pharmacy benefits with your Premier Health Employee Plan member ID card. Your card will allow you to fill a prescription at a Premier pharmacy, participating retail pharmacy,

More information

NCPDP B1 Transaction Billing Request

NCPDP B1 Transaction Billing Request Texas Vendor Drug Program Pharmacy Provider Payer Sheet NCPDP B1 Transaction Billing equest Effective Date January 15, 2017 The VDP Pharmacy Provider Payer Sheets are available online at txvendordrug.com/about/policy/payer-sheets.

More information

CHAPTER 12 SECTION 3.1 TRICARE - PHARMACY BENEFITS

CHAPTER 12 SECTION 3.1 TRICARE - PHARMACY BENEFITS TRICARE/CHAMPUS POLICY MANUAL 6010.47-M DEC 1998 TRICARE CHAPTER 12 SECTION 3.1 Issue Date: July 8, 1998 Authority: 32 CFR 199.17 I. POLICY A. The Managed Care Support (MCS) Contractor shall provide an

More information

Elmira School District Health and Dental Plan Plan Amendment

Elmira School District Health and Dental Plan Plan Amendment Elmira School District Health and Dental Plan Plan Amendment The Elmira School District has adopted and amended the following provision for the self-funded Health and Dental Plan, restated April 28, 2005:

More information

Prescription Medication Rider

Prescription Medication Rider Prescription Medication Rider Rx Member Cost-Sharing: $16/$40/$80/$90 HealthyU HIA/HRA According to this prescription medication program, you may receive coverage for prescription medications in the amounts

More information

TITLE 317. OKLAHOMA HEALTH CARE AUTHORITY CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE SUBCHAPTER 5. INDIVIDUAL PROVIDERS AND SPECIALTIES PART 5

TITLE 317. OKLAHOMA HEALTH CARE AUTHORITY CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE SUBCHAPTER 5. INDIVIDUAL PROVIDERS AND SPECIALTIES PART 5 TITLE 317. OKLAHOMA HEALTH CARE AUTHORITY CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE SUBCHAPTER 5. INDIVIDUAL PROVIDERS AND SPECIALTIES PART 5. PHARMACIES 317:30-5-70.3. Prescriber identification numbers

More information

MARCH 1, Referred to Committee on Health and Human Services

MARCH 1, Referred to Committee on Health and Human Services EXEMPT (Reprinted with amendments adopted on May, 0) FOURTH REPRINT S.B. SENATE BILL NO. SENATORS RATTI, CANCELA, SPEARMAN, CANNIZZARO, WOODHOUSE; ATKINSON, DENIS, FORD, MANENDO, PARKS AND SEGERBLOM MARCH,

More information

Florida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter April 1, 2016 through June 30, 2016

Florida Medicaid Prescribed Drug Service Spending Control Initiatives. For the Quarter April 1, 2016 through June 30, 2016 Florida Medicaid Prescribed Drug Service Spending Control Initiatives For the Quarter April 1, through June 30, Report to the Florida Legislature December 2017 [This page intentionally left blank.] Table

More information

Martin s Point Generations Advantage Policy and Procedure Form

Martin s Point Generations Advantage Policy and Procedure Form Martin s Point Generations Advantage Policy and Procedure Form Policy #: PartD.923 Effective Date: 4/16/10 Policy Title: Part D Transition Policy Section of Manual: Medicare Prescription Drug Benefit Manual

More information

Health PAS-Rx Help Desk Hints Version 1.58 West Virginia Medicaid Health PAS-Rx Help Desk Hints

Health PAS-Rx Help Desk Hints Version 1.58 West Virginia Medicaid Health PAS-Rx Help Desk Hints West Virginia Medicaid Health PAS-Rx Help Desk Hints Date of Publication: 12/15/2017 Document Version: 1.58 Privacy and Security Rules The Health Insurance Portability and Accountability Act of 1996 (HIPAA

More information

2018 FAQs. Prescription drug program. Frequently Asked Questions from employees

2018 FAQs. Prescription drug program. Frequently Asked Questions from employees 2018 FAQs Prescription drug program Frequently Asked Questions from employees September 2017 Prescription drug program Questions we ve heard our employees ask Here are some commonly asked questions about

More information

Prescription Drug Rider

Prescription Drug Rider Prescription Drug Rider P L A N C E R T I F I C A T E Drug 516 Jan 2014 01:14 HMSA s Prescription Drug Rider This summary is intended to provide a condensed explanation of plan benefits. Certain limitations,

More information

ProCare Rx/Jai Medical Systems Managed Care Organization 2018 Therapeutic Formulary

ProCare Rx/Jai Medical Systems Managed Care Organization 2018 Therapeutic Formulary ProCare Rx/Jai Medical Systems Managed Care Organization 2018 Therapeutic Formulary This formulary describes the circumstances under which pharmacies participating in a particular medical benefit program

More information

Patient Enrollment Guide

Patient Enrollment Guide Patient Enrollment Guide Completing the Patient Enrollment Form Prescribing Healthcare Professional (HCP) Contact Information HCP Fax Number Please list accurate fax number where patient Summary of Benefits

More information

Texas Vendor Drug Program. Pharmacy Provider Procedure Manual Pricing & Reimbursement. Effective Date. March 2018

Texas Vendor Drug Program. Pharmacy Provider Procedure Manual Pricing & Reimbursement. Effective Date. March 2018 Texas Vendor Drug Program Pharmacy Provider Procedure Manual Pricing & Reimbursement Effective Date March 2018 The Pharmacy Provider Procedure Manual (PPPM) is available online at txvendordrug.com/about/policy/manual.

More information

REMINDER: PROVIDERS MUST ADHERE TO NCCI GUIDELINES WHEN SUBMITTING CLAIMS

REMINDER: PROVIDERS MUST ADHERE TO NCCI GUIDELINES WHEN SUBMITTING CLAIMS Volume I, 2015 COOK CHILDREN S HEALTH PLAN MEMBERSHIP: JANUARY 2015 CHIP: 20,240 STAR: 97,836 REMINDER: PROVIDERS MUST ADHERE TO NCCI GUIDELINES WHEN SUBMITTING CLAIMS The Patient Protection and Affordable

More information

Your Pharmacy Benefits Handbook

Your Pharmacy Benefits Handbook Your Pharmacy Benefits Handbook Summary of FCPS Prescription Benefits Available Through CVS Caremark Pharmacy Benefit Manager for Aetna/Innovation Health and CareFirst BlueChoice Advantage Plans Plan Year

More information

SPD Prescription Drugs Plan

SPD Prescription Drugs Plan Prescription Drugs Plan 08/01/2017 3-1 Your Prescription Drug Benefits The prescription drug benefit available to you is based on the medical plan in which you are enrolled. Regardless of the benefit design

More information

Alabama Medicaid Pharmacist

Alabama Medicaid Pharmacist Alabama Medicaid Pharmacist Published Quarterly by Health Information Designs, Inc., Fall 2005 A Service of Alabama Medicaid Medicare Modernization Act Adopted in December 2003, the Medicare Modernization

More information

All Indiana Health Coverage Programs Physicians, Podiatrists, Dentists, Hospitals, Clinics, Mental Health Providers, and Pharmacies

All Indiana Health Coverage Programs Physicians, Podiatrists, Dentists, Hospitals, Clinics, Mental Health Providers, and Pharmacies Indiana Health Coverage Programs P R O V I D E R B U L L E T I N BT200132 AUGUST 10, 2001 To: All Indiana Health Coverage Programs Physicians, Podiatrists, Dentists, Hospitals, Clinics, Mental Health Providers,

More information

AUGMENTATIVE COMMUNICATION DEVICES (ACDS) CSHCN SERVICES PROGRAM PROVIDER MANUAL

AUGMENTATIVE COMMUNICATION DEVICES (ACDS) CSHCN SERVICES PROGRAM PROVIDER MANUAL AUGMENTATIVE COMMUNICATION DEVICES (ACDS) CSHCN SERVICES PROGRAM PROVIDER MANUAL JUNE 2018 CSHCN PROVIDER PROCEDURES MANUAL JUNE 2018 AUGMENTATIVE COMMUNICATION DEVICES (ACDS) Table of Contents 10.1 Enrollment......................................................................

More information

SecurityBlue HMO. Link to Specific Guidance Regarding Exceptions and Appeals

SecurityBlue HMO. Link to Specific Guidance Regarding Exceptions and Appeals SecurityBlue HMO Conditions and Limitations Potential for Contract Termination Disenrollment Rights and Instructions Exceptions, Prior Authorization, Appeals and Grievances Out-of-Network Coverage Quality

More information

Get the most from your prescription-drug benefit

Get the most from your prescription-drug benefit Get the most from your prescription-drug benefit 2018 Welcome to Express Scripts At Express Scripts, the company chosen by Ohio State Highway Patrol Retirement System to manage your prescription-drug benefit,

More information

BlueScript Pharmacy Program Endorsement

BlueScript Pharmacy Program Endorsement BlueScript Pharmacy Program Endorsement This Endorsement and the BlueScript Pharmacy Program Schedule of Benefits are to be attached to, and made a part of, your Benefit Booklet. The Benefit Booklet is

More information

Arkansas Medicaid Health Care Providers - Pharmacy. SUBJECT: PROPOSED - Provider Manual Update Transmittal #74

Arkansas Medicaid Health Care Providers - Pharmacy. SUBJECT: PROPOSED - Provider Manual Update Transmittal #74 Arkansas Department of Human Services Division of Medical Services Donaghey Plaza South P.O. Box 1437 Little Rock, Arkansas 72203-1437 Internet Website: www.medicaid.state.ar.us TO: Arkansas Medicaid Health

More information

Summary Plan Description Accenture Prescription Drug Plan

Summary Plan Description Accenture Prescription Drug Plan Summary Plan Description Accenture Prescription Drug Plan Effective January 1, 2018 Group Number: ACCRXS1 TABLE OF CONTENTS SECTION 1 - WELCOME... 1 SECTION 2 PLAN HIGHLIGHTS... 3 SECTION 3 - ADDITIONAL

More information

Pharmaceutical Management Commercial Plans

Pharmaceutical Management Commercial Plans Pharmaceutical Management Commercial Plans 2015 Toll Free Contact Number: (888) 327-0671 Medical Management: (810) 733-9711 Visit our website at: MclarenHealthPlan.org Introduction Pharmaceutical Management

More information

SPEECH-LANGUAGE PATHOLOGY (SLP) SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL

SPEECH-LANGUAGE PATHOLOGY (SLP) SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL SPEECH-LANGUAGE PATHOLOGY (SLP) SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL JANUARY 2018 CSHCN PROVIDER PROCEDURES MANUAL JANUARY 2018 SPEECH-LANGUAGE PATHOLOGY (SLP) SERVICES Table of Contents 37.1

More information

Your Prescription Drug Plan. Prescription Drug Plan CONTENTS PRESCRIPTION DRUG PLAN. (Performance Pipe Hourly Employees)

Your Prescription Drug Plan. Prescription Drug Plan CONTENTS PRESCRIPTION DRUG PLAN. (Performance Pipe Hourly Employees) (Performance Pipe Hourly Employees) Prescription Drug Plan CONTENTS Your Prescription Drug Plan...C-1 How the Plan Works...C-2 What s Covered...C-7 Precertification...C-7 Prescription Drug Management Programs...

More information

Introduction to UnitedHealthcare Community Plan of California/Medi-Cal

Introduction to UnitedHealthcare Community Plan of California/Medi-Cal Introduction to UnitedHealthcare Community Plan of California/Medi-Cal Welcome/Agenda: Mission/Vision UnitedHealthcare Community Plan of California/Medi-Cal Member Eligibility and Benefits Notification

More information

(Prescription coverage)

(Prescription coverage) (Prescription coverage) (CVS Caremark) 2018 Draft TABLE OF CONTENTS DEFINITIONS... 1 PRESCRIPTION DRUG COVERAGE... 4 EXCLUSIONS... 6 COORDINATION OF BENEFITS SECTION... 6 CVS CAREMARK INTERNAL CLAIMS DETERMINATIONS

More information

UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Pharmacy Schedule of Benefits

UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Pharmacy Schedule of Benefits CALIFORNIA UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California Pharmacy Schedule of Benefits (FOR HSA-QUALIFIED DEDUCTIBLE PLANS) Summary of Benefits Retail Pharmacy Copayment

More information

December 1, 2018 Medicaid Pharmacy Provider Manual

December 1, 2018 Medicaid Pharmacy Provider Manual Pharmacy Services Covered Services & Limitations Module Final, Revision 15, December 1, 2014 December 1, 2018 Medicaid Pharmacy Provider Manual Wyoming Department of Health Division of Healthcare Financing

More information