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Weekly Update
Care December 27, 2007
In The Know…
PBM and Plan Updates
Generic Altace® Now Available
Nationwide Updates
Cobalt Laboratories launched Ramipril – the generic form of Altace – on 12/26. Altace is an ACE inhibitor used in the treatment of hypertension and has retail sales of • Effective 1/1/08, 4D will begin processing claims for AAA of Michigan, Asahi Kasei Plastics North America, Inc. (APNA), Community Network Services, Central Healthcare Service Inc. Protonix® Now Available in Generic Form
and Wasthenaw County Road Commission BIN #: 600428, PCN Teva Pharmaceuticals just received approval on their generic form of blockbuster drug Protonix. With approximately $2.02 billio n in retail sales, Protonix is a proton pump inhibitor (PPI) • Effective 01/01/08, Aetna will begin processing claims for Capital that is used to treat acid-related stomach and throat problems One’s new members. Please check the members ID cards to such as acid reflux or GERD. Pantoprazole (pan-TOE- ensure that they are processed under the correct carrier. BIN # pruhzole) will be exclusively available from Teva Pharmaceuticals for the next 180 days and has been added • Notice: Argus mailed duplicate checks to pharmacies for
to the Cardinal Health SOURCE Generics offering. Network- Nov 20, 2007 cycle. Please note that only one check
Generic Name Strength Size Form Compare To Supplier
should be presented to your bank, if the duplicate check is NDC # Pantoprazole Sodium DR 20 mg 90 Tablet Protonix®
presented also, you will incur charges. If you receive a duplicate payment, please send it to Argus Health Systems, Inc. Attn: Pantoprazole Sodium DR 40 mg 90 Tablet Protonix® Teva Fiduciary Accounting Department 1300 Washington Street Kansas City, MO 64105. Questions regarding the duplicate payment may be directed to the Recon Customer Service Voluntary Distribution Restriction Imposed on
Department @866.211.9459 or via e-mail at Methadone Products
As of 1/1/08, manufacturers have voluntarily agreed to restrict the distribution of Methadone 40 mg to licensed addiction • Effective 1/1/08, Priority Health Commercial Transition Logic has been updated to resemble the Medicare Transition Logic. If a treatment facilities and hospitals. Product returns are not necessary, and the distribution of member is within their eligibility period and a claim is denied for Methadone 5 mg and 10 mg tablets remains unchanged and PA, non-formulary, or step-therapy required, error message will continue to be available to all authorized registrants “TRANSITION MBR SUBM AUTH 75222” will appear. Please re-
including retail pharmacies. More information about the voluntary withdrawal can be found on Mallinckrodt’s Web site • Effective 1/1/08, the current Barrier Therapeutics Vusion & Xolegel $10 Copay Patient Program has been extended • All Barrier Patient 1st Cards with a 12/31/07 expiration date will
continue to be active and accepted for this program. MAC Successes
Effective 1/1/08, Argus will begin processing Medicare Part D Didasone 400mg
claims for Touchstone Health Plan BIN #: 012353, PCN #: thadone 40mg
• Effective 1/1/08, Argus will begin processing Medicare Part D claims for Virginia Premier Gold BIN #: 012353, PCN #: HealthNet 6 million lives
Medco 62 million lives
Caremark
• Effective 1/1/08, Caremark will begin processing Medicare Part D claims for Mennonite Mutual Aid Association. BIN # : 004336, Isometh/APAP/Dichloral 65-
Desoximetasone 0.05%
• Effective 1/1/08, Caremark will begin processing Medicare Part D claims for Health Net BIN #: 004336, PCN #: ADV, Group #: Medco 62 million lives
Medco 62 million lives
Continued on Page 2 of this Managed Care Weekly Update
For questions and additional information, please contact the Managed Care Connection Help Desk at 877.292.3196 Weekly Update
Care Page 2
PBM and Plan Updates
Nationwide Updates
Effective immediately, Caremark has added additional members of the National Association of Counties (NACo), BIN #:004336 Catalyst Rx
• Effective 1/1/08, Catalyst Rx will begin processing claims for The Gold Strike Hotel and Casio Express Scripts
• Effective 1/1/08, Express Scripts has implemented a Prior Authorization Program for Advair® and Symbicort® , also the Board of Regents of the University System of Georgia (BOR) has added drugs to its Preferred Drug List. Effective 12/31/07 (11:59 p.m.), pharmacies will no longer be able to reverse any claims for RMHP (Rocky Mountain Health Plans) Commercial, Medicaid or CHP+ Member with the DOS 2007. Please have all reversals completed prior to this time HealthTrans
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Effective 1/1/08, HealthTrans will begin to process claims for Cannery Casinos and Resorts. BIN # : 011677, PCN # : HT, Group name: Cannery Casinos and Resorts Group # : 89148CCR, 89148CCR2, 89148RP, 89148RP2, 89148MC and 89148MC2 • Effective immediately, Health Trans is processing for cash discount programs HT Access Preferred and HT Access Premium BIN #:011867, PCN #: HT, Group #: 801110, 801110A also Health Trans Access (HT Access) BIN #:011867, PCN #: HT, Innoviant
• W hen processing Medicare Part D claims for Innoviant, pharmacies must submit the claim on-line via POS adjudication within 30
da ys of dispense date. If the claim rejects contact the helpdesk at 800.794.1086. If pharmacies need to submit a reversal, online reversals are accepted up to 60 days after the claim was processed, after that time a manual claim is necessary. Reminder: When
contacting the service center have your NCPDP/NPI #, claim #, exact error msg, steps you took to process the claim. (representatives are not able to see the claims) Effective 1/1/08, Innoviant will begin to process claims for KelseuCare Advantage. BIN #:610127, PCN #: 02330000, Group #:024600001 • Effective 1/1/08, Medco will begin processing Medicare Part D claims for Preferred Care USA Care. BIN # : 610014, PCN # : Opus Health
•
Effective 1/1/08, Opus Health will begin to process claims for the Amrix ER (copay) Program. BIN # : 601341, PCN # OHCP, Effective immediately, Opus Health is taking part in the Detrol LA Cares Card program. BIN # : 601341, PCN # OHCP, RxA merica
• Effective 1/1/08, Molina will implement a new Medicare Part D program called Molina Medicare Options. Molina Medicare Options Plus (formerly Molina Advantage) will still be offered to LIS beneficiaries, BIN # : 012189, PCN # : Molina Medicare Options=5035, • Effective 1/1/08, RxAmerica will begin to process claims for Unison Advantage of Mississippi, Advantage of Arkansas, Advantage of Effective 1/1/08, SXC will begin to process claims for AHC, CIWF, GOELLNER, MICROFIBRES, NOVANT, RJ REYNOLDS, NOVANT INFERTILITY BIN #: 610593, PCN #: SXC Effective 1/1/08, WellPoint will begin to process claims for: Wal-Mart WMS BIN #: 610575, South Carolina Medicaid BIN #: 610575, Lumenos/CDHP BIN #: 610575, PCN #: LUMENOS, Unicare/Solaura/CDHP BIN #: 610575, PCN #: CDH9999, Shaker Heights • Effective 1/1/08, WHI will begin to process claims for TriMas Corporation. BIN #: 603286, PCN #: 01410000, Group #: 515069, please ask the member for their ID # when submitting their claim, it will be their social security number. For questions and additional information, please contact the Managed Care Connection Help Desk at 877.292.3196 Continued on Page 3 of this Managed Care Weekly Update
Weekly Update
Care Page 3
PBM and Plan Updates
Nationwide Updates
Effective 1/1/08 Caremark will begin to process Medicare Part D claims for MD Care Health Plan. BIN # : 004336, PCN # : ADV, Caremark
• Effective 1/1/08, Caremark will begin processing Medicare Part D claims for AMERIGROUP Florida AMERIVANTAGE. BIN #: 610415, PCN #: PCS, Group #: MD72FLMA FL
Envi sions RxOptions
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Reminder- Members with the FLORIDA DISCOUNT DRUG cards will pay a $1.50 per prescription administration fee, unless the pharmacy’s U&C is less than the calculated price, then no fee will be applied. Health Trans
• Effective 1/1/08, HealthTrans will begin to process claims for Working Rx. BIN #: 012973, PCN # WRXCC Note: Florida Division
of Workers' Compensation (DWC) requires the dispensing pharmacist's Florida Department of Health (DOH) License number on all Workers' Compensation prescription claims submitted GA
SXC
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Notice: SXC has confirmed that there have been some recent EFT payment issues with Georgia Medicaid. The week of December 17, payments were posted twice; this issue has been resolved, as the double payment has been reversed. If you have question regarding this issue only contact the SXC Technical Call Center at 866.525.5826 Exp ress Script
• Effective 1/1/08, Blue Cross Blue Shield of Massachusetts (BCBSMA) will be adding a significant number of new lives to their existing prescription drug program. Not all of the new members will have their new ID cards by 01/01/08; they will be using the enrollment forms until they receive their ID cards. Please note that the enrollment forms contain all of their claim information, please read these forms carefully for processing information Effective 1/1/08, ALTABAX, TEKTURNA (EPA), TYZEKA, and VYVANSE will become Tier 3 medications on the Capital BlueCross BCBSM
•
NOTICE- Effective immediately BCBSM’s CFI department has issued the following alert: In Southeast and Lower Central Michigan a large group of individuals are passing fraudulent prescriptions for Oxycontin 80 mg (80 to 120 tablets).
Please make your staff aware of the following details:
• The individuals passing the prescriptions are usually dressed in medical scrubs and possess photocopies of the driver’s license and BCBSM ID card of the individual named on the prescription. • The individuals are posing as the patient’s caregiver, saying the patient is too sick to pick up the prescription. • The prescriptions are written as DAW for Oxycontin 80 mg. • The prescriptions are being written under 30-40 different doctors (changing daily). • The prescriptions have an actual physician DEA number on them. • The phone number listed on the prescription is being answered when called during business hours. After hours, an answering machine is used. If you are unsure of the validity of a prescription, please look up the physician’s actual phone number on record to verify if the prescription is valid, rather than using the phone number noted on the prescription. • A driver has been seen in the parking lot waiting for the individual to pick up the prescription. If you notice a suspicious- looking individual, please contact your law enforcement office. For questions and additional information, please contact the Managed Care Connection Help Desk at 877.292.3196

Source: http://extww02a.cardinal.com/us/en/pharmacies/offerings/mcareconnect/pdf/MCC%20Weekly%20Update%2020071227.pdf