Pharmacy providers may go to CVS/Caremark for payer sheets and additional network or processing information. One-stop shop Because we manage both Medicare and Medicaid coverage, we're pleased to offer you the benefits of working with a single point of contact and billing for your Medicare-Medicaid patients. Non-preferred DAAs will require a PA explaining why MAVYRET is not clinically appropriate: MIRx_PAfaxform_General.pdf (magellanrx.com). What is the co-pay for MAVYRET under this agreement? }}Ic-vPJv5 &fRCKJp,LY|-+$ll gr*IA4&LR#1)0G>mze3lk6t_Ks=T[||8\PUd[z70>ks{jn64`6=#nGJ6&$!'S$t6}Tk6/W[-uV_I3vCKiXqS;fC-3{K[TDV#)NeHE1 A3I'\c|M!^ endobj U?o=3(0 Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. ;Q%8UbZD@;CKw1R+hsE3Uhe[Kmb0ey2se,3 2m+ :M6~Pg(z1Q Y _d.in?KW5 &nTUlASll#%kkvM c:]@NPaffZ9nn$b3]IzbOXNil3X%?iDK$3|@HV(UZ31X/Jz:.oPm!cHK WXGuB -]MMP6y\5%G\@s$1~O1mJ66jWR ]9XIeABzQql0[*)R(GQ2 Q6a6VB#g!M6ju&0Mn'\"hG?ad]wZ R]\3]_q1Ixwy}u^W;p^Jq+-T This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. Will there be specific PA criteria listed in the PDL for the non-preferred DAAs? View 2023 Enrollment Information. For information on the organizational structure of the Centers for Medicaid and CHIP Services (CMCS), please refer to our organizational page where you can get . <> 4 0 obj The Medical Director may need additional information before making a decision. We require doctors to obtain a PA before prescribing or giving out the following: Aetna Better Health of Michigans Medical Director decides if a drug is denied or approved using MDHSS guidelines. H0192_001_WEB_1494050. A formulary is a list of drugs that Aetna Better Health covers and the formulary consists of the MDHSS PDL and Common Formulary. Limitations, co-payments, and restrictions may apply. Reasons to choose Priority Health. Contact UPHP by emailing the Customer Service Departmentor by calling 1-800-835-2556. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. Medicaid.gov Mailbox: Medicaid.gov@cms.hhs.gov. TTY Local: 410-786-0727. You are now leaving Aetna Better Health of Michigans website. Medicaid Drug Rebate Program Labeler List Reference - To help you more easily identify Medicaid rebatable NDCs, we are posting a monthly reference list here. You may go to our website to search for an in-network pharmacy near your zip code. Certain drugs on the Aetna Better Health of Michigan formulary have quantity limits and are listed on the formulary with QLL. Regardless, it is important that you understand how the Michigan Medicaid . https://michigan.magellanrx.com/provider/external/medicaid/mi/doc/en-, Aetna Better Health Premier Plan (Medicare-Medicaid), Children's Special Health Care Services (CSHCS), Case/Disease Management (Care Management), Non-formulary drugs that are not excluded under a States Medicaid program, Prescriptions that do not follow our guidelines (like quantity limits, age limits or step therapy), Brand name drugs, when a generic is available, Drugs on the formulary have been tried and does not work (i.e., step therapy), No other drugs on the formulary would work as well as the drug requested, The request is acceptable by the Federal Drug Administration (FDA) or is accepted by nationally noted experts. Medicaid Office Location Michigan Department Community Health 201 Townsend Street Capitol View Building Lansing, MI 48913 Medicaid Office Phone Number The phone number to call the Michigan Medicaid office is 800-642-3195 or in state call 517-373-3740. If you do not intend to leave our site, please click Close. They must show why a formulary drug will not work for you. Molina Healthcare Healthy Michigan Plan. This plan is available to anyone who has both Medical Assistance from the State and Medicare. 1-888-417-3479 HAP Choice West Michigan HMO Option 1 HAP Choice West Michigan HMO Option 1. wwx$AZS@NJ7B>a '2"adi=#IP$he[@HH*[sM'#(@7%}1JJI#Sdi9q As an Aetna Better Health of Michigan member, you have the right to certain prescription drug benefits. When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium. (800) 888-9885 (TTY: 711) MondayFriday, 8 am to 8 pm. Providers Providers homepage Coronavirus (COVID-19) Prescription drug coverage determination. Ohio BWC. endstream endobj 129 0 obj <>/Metadata 3 0 R/Pages 126 0 R/StructTreeRoot 7 0 R/Type/Catalog/ViewerPreferences 144 0 R>> endobj 130 0 obj <>/MediaBox[0 0 792 612]/Parent 126 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 131 0 obj <>stream For confirmation of carved out agents use the FFS drug search tool. You may also request a printed copy of this formulary by calling Member Services. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Michigan, All Rights Reserved. Are prisoners covered by Medicaid upon release and therefore able to get MAVYRET without a PA? The Upper Peninsula Health Plan (UPHP) is a managed care organization for people covered by Michigan Medicaid, MIChild, Childrens Special Health Care Services, and the Healthy Michigan Plan. Aetna Better Health of Michigan will fill prescriptions for a seventy-two (72) hour supply if the member is waiting for a decision by the Plan. You are leaving our website and going to a non Medicare-Medicaid Plan website. GROUP: RX8826. Hep C treatment is carved out to MDHHS fee for service (MagellanRx) and as 4/1/2021 the system is set up to approve Mavyret for up to a 12 week supply. The QLLs are based on the MDHSS PDL and Common Formulary. Meridian Health Plan 004336 MCAIDADV RX5492 Molina Healthcare of Michigan 004336 ADV RX0506 Priority Health Choice 003858 MA PHMEDCD United HealthCare Community Plan, Inc. 610494 4242 ACUMI Upper Peninsula . If the member gives an ok, CVS Caremark will call the prescribing provider to get the prescription. Need help with your login or our website? Hep C treatment no longer requires a prior authorization if using the State Preferred PDL agent Mavyret. These counts do not include the Consumer Assessment of Healthcare . % However, many pharmacies may default to dispensing in 4-week increments, unless the script specifies an 8- or 12-week supply. Healthy Michigan is a low cost program that offers health coverage to adults age 19 - 64 who do not qualify for Medicaid or Medicare and whose income is at or below 133% of the federal poverty level. This information may include the following: Both parties will be told of the decision through the telephone or mail. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 Yes. R\J=lSkSeD!LOx[{Xp7M?tOF~~x,O:JX t G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 For more information on which test kits are covered, please clickhere. Aetna Better Health of Michigans pharmacy prior authorization (PA) process is designed to approve drugs that are medically needed. Please see the below FAQ for further information for prescribers of Mavyret as part of the We Treat HEP C Initiative: ABH of MI covers COVID-19 self-test kits through the pharmacy benefit without a prescription. Can patients fill their MAVYRET prescription at any Specialty or Retail Pharmacy? <> MAVYRET is covered for beneficiaries on Emergency Service (ESO) Medicaid. This is especially true if you choose to apply for benefits in person at an acceptance facility. Aetna Better Health of Michigan Members must have their prescriptions filled at a in network pharmacy to have their prescriptions covered at no cost to them. By Payer Id, every provider and insurance company or payer systems connect electronically with each other. stream Meridian Health Plan of Michigan, Inc. is rated 4 out of 5 in NCQA's Medicaid Health Insurance Plan Ratings 2016-2017 and NCQA's Medicaid Health Insurance Plan Ratings 2017-2018. A Specialty pharmacy fills drugs but has other services to help you. All MDHHS registered prescribers, including non-specialists, will be able to prescribe Mavyret as of 4/1/2021. What has to be submitted with a MAVYRET claim now that no PA is required? Plan H9572_801 RxBIN 610014 RxGRP MEDPRIME RxGRP BCBSMAN Enrollee Name VALUED CUSTOMER XYL999999999 Enrollee ID Issuer (80840) 9101003777 XXXXX Group Number 01/2019 Issued Medicare PLUS 159 0 obj <>stream ck${uD$FY.-jilxp2S: :G@lvo:;*^r7:L'11ts*Q#M3ETX{"TK0loB_BL%Ka| xaRs)b" yb^p{oN,y a1"9auL]] NsZ5_MfvQ_s!.H83'I $WyU.Oxo.&oGXsmB ?*!>Eu+^$%Mi)+{"_t3sTXIveO|M3)9=gfop^0&k[TcZAnG% What is the co-pay for a non-preferred DAA? The preferred pen needles are BD. 143 0 obj <>/Filter/FlateDecode/ID[<14CA7E9AD6E845448BEA8143AE3132BF><6279EB9BF921144B8AD37941F7D540C0>]/Index[128 32]/Info 127 0 R/Length 84/Prev 101415/Root 129 0 R/Size 160/Type/XRef/W[1 3 1]>>stream 3 0 obj Local: 410-786-3000. The preferred pen needles are BD. <>/Metadata 7920 0 R/ViewerPreferences 7921 0 R>> Baltimore, Maryland 21244-1850. endobj UPHP Advantage (HMO-POS)& UPHP Choice (HMO), UPHP Prior Authorization and Notification Requirements, Espaol | | | Assyrian | Ting Vit | Shqip | | | Polski | Deutsch | Italiano | | | Srpsko-hrvatski | Tagalog. Aetna Better Health of MI members may use the following information along with the ID number to process prescriptions at network pharmacies: BIN: 610591. They must include any medical records needed for the request. 32-C2 CARDHOLDER ID M Medicaid ID Number <Michigan Medicaid> 10-digit ID 31-C1 GROUP ID MIMEDICAID R 33-C3 PERSON CODE Imp Guide: Required if needed to . The Pharmacy should indicate level of service 3 (emergency) on the claim. Learn more about PriorityMedicare D-SNP SM. ), will they be able to complete their course of therapy (i.e., refills)? endobj %PDF-1.7 % Drugs having step therapy are listed on the formulary with STEP. 0FY( Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. These drugs are covered by MDHSS Fee-or-service (FFS) using the Magellan Pharmacy Benefit Manager. m~@tR8r!#d'$G!rS`.&#Tv5mu1@[AwasrWLeRK6Z6ev &oVV[]yQ5JGqj,&}6"aewDt*&I=g{`NMh3_:%8[7u{89t,3krmrr+ HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. By requesting your doctor to write a prescription for a 90-day supply with up to one year of refills. To find out it if a drug that you take is covered, you can check the MDHSS PDL and Common Formulary for the most current coverage status. Xfe ZfI9Ne)[mJK\6ggSm6B'+^&bc, l~;vD>lLIBE?v~s+ Contact information For more information or assistance regarding Care Management, please contact Customer Service at 888.975.8102. AHCCCS Health Plans BIN PCN Group Number PBM Phone Number AHCCCS FFS 001553 AZM OptumRx 855-577-6310 AHCCCS FFS - Secondary to Commercial 001553 AZM OptumRx 855-577-6310 AHCCCS FFS - Dual Eligibles for Covered OTC Prescriptions 001553 AZM OptumRx 855-577-6310 United Healthcare Community Plan (Acute, CRS, DD, LTC) 610494 4100 ACUAZ OptumRx . Aetna Better Health also covers diabetic supplies. Medications covered on the Michigan Department of Health and Human Services (MDHSS) Single Preferred Drug List (PDL) can be found here, Medications covered on the MDHSS Common Formulary can be found here, For a list of PDL alternatives click here. When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium. [Vf,c.DwN`h`(@GBt dr x lth0t3CM!X$I,e?D Fo#aCR[v7G|Ec$Cq_ &k>L8 p){Tn$i(zD$T%BX7"z8I4}zCtT|`I&| <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> #IAY#=p^{aDLETD%uWF\,(-XJoH K@Iv ?3o3 kPtPd])*Ai#xL`NQM"3D(7;u}'S-vG4@ljx[{`##07zDHFb7WNaWy1O/D]='mRB_;9^6w1ncGfVpO# K{8I^hS;bI3 =uQgOsv?9i. People 65 and older with Medicaid may also be eligible for a Dual Eligible Special Needs Plan, or D-SNP. We are one of the top-rated Medicaid plans in Michigan, with a rating of 4 out of 5 in NCQA's Medicaid Health Insurance Plan Ratings 2021-2022. Your doctor can request an override step therapy and/or a quantity limit by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. 7')<7hm?O-8~h*we/x_']\F_A)R6O CB{pB/-jXkthNb. CVS Specialty Pharmacy will assist you in filling your specialty drug. 31147. The Specialty Drug Program has special services for you: You can contact CVS Specialty Pharmacy at1-800-237-2767; TTY/TDD:1-800-863-5488from 7:30 a.m. (EST) to 9:00 p.m. (EST) time, Monday Friday. Pharmacies are authorized to dispense up to 102 days of therapy at a single time. This information is not a complete description of benefits. If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 600428 06210000 n/a . Submenu for Insurance through your employer, Learn more about individual and family plans, Medicaid and MI Health Link Pharmacy Providers, Medicaid Drug Rebate Program Labeler List Reference. The step therapy program requires certain drugs, such as generic drugs or formulary brand drugs to be prescribed before a specific second-line drugs is approved. Updates to the PDL/Common Formulary can be found online using the formulary documents linked below: MDHSS carves out specific classes of drugs. We help Medicaid members get the health care they need in 32 Michigan counties across the state. r-zr;5usj^7hUdCtt~qNepP}SUi?|=HHFJ{ak]6jF f/Tu:oA\6ybwYXTY6RHFcbBk[L!bp Whacv1*68$J~4?XXWkl&xP*Ue-tDQrXta@[ We take care of it all, including medical, dental, vision and mental health benefits. TTY Toll-Free: 800-877-8339. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. Tools are available in alternate formats. HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. Get the latest information about COVID-19, the vaccine and PHE wind down. D;wb3\\iUvYwLk*hC.D%)3g8?aVE\7/E @[axlg#tRxb#TbX ZbE9L(VC_GGSQ6RtC;%/1x [s,I#@`BN M9*lrt5/EY8&dxj ]|x(-Vj2dRil?hh\yLW R:9~K[eB`B\u( :|$SWf p#*_.Iu/37Z* f(Yvz((j 1st Medical Network - Atlanta GA. Aetna Better Health of Michigan covers prescription drugs and certain over the counter drugs when presented with a prescription at a pharmacy. Last Updated: 03/31/2022. If you have any questions about a drug that is not listed, please call Member Services toll-free at1-866-316-3784(TTY711), 24 hours a day, 7 days a week. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. Toll-Free: 877-267-2323. Contact UPHP by emailing the Customer Service Department or by calling 1-800-835-2556. %PDF-1.7 Our portals will be unavailable during this period. hbbd```b``Sd5d`YML^?'l0yH2>HW4$21@ y0 Commercial and Medicaid BIN: 610494 PCN: 9999 COMMUNITY HEALTH BIN 610613 PCN: 2417 Maryland Medicaid BIN: 610084 PCN RXSOLPRD ProAct BIN 017366 PCN: 9999 . CVS Caremark will call the prescribing provider to get the prescription with the members ok. Log in and sign up for mail service online. This website can help you find all of the materials you need to understand your benefits, how to get care, and how to have good health habits. The preferred Glucose meters and Test Strips are J&J One Touch products. The claim will be paid if submitted in accordance with our Pharmacy Claims Processing Manual: Will MAVYRET be covered without a PA in the rare case a patient requires 12 weeks of therapy? endstream endobj startxref Forms should be mailed to: Which type of provider may prescribe Mavyret? Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. We are working on a Targeted Case Management benefit that provides support and resources for individuals recently released from a correctional facility, including some degree of in-reach, but this has not yet been implemented. You can talk to a Pharmacist 24 hours a day, seven days a week, Disease-specific education and counseling are available by CVS, Care Coordination for you and your doctor, Delivery of Specialty drugs to yourhome and/or your doctors office is available for drop off and pick up at any CVS Pharmacy location (including those inside Target stores*). 6Q~otUs9("+r_iJ s-l["XP (QSwRWPN4Z1& &>Soy^LEOX1aL5`h!&9{Q]N0p When the member receives the form, the member fills it out and mails CVS Caremark the prescription and the order form. Provide free aids and services to people with disabilities with communicate with us, such as: Qualified sign language interpreters The UPHP wants to help keep you and your family healthy. hVmk9+RV-_Sr ac9n#N} Aetna Better Health of Michigan offers mail order prescription services through CVS Caremark. Members Members homepage Find a drug Request for redetermination. Your doctor will complete this form. H+XRWKdR0"}XJS:i1fUnv~Fy&Uw'* The specialty drug list is availablehere. We will be conducting planned maintenance on our site from Friday, 10/14 at 9:30 PM until Saturday, 10/15 at 12:30 AM. PCN: ADV. 13162. Can more than 4 weeks of therapy be prescribed at a single time (e.g., 8 weeks of therapy, or less frequently 12 weeks of therapy, as opposed to 4 weeks with refill(s))? RxBIN: 003858 RxPCN: MA RxGRP: HAPMCD. Learn More. For Medicaid, co-pay for MAVYRET is $1, and co-pay for non-preferred DAAs are $3. In federal fiscal year (FFY) 2019, voluntarily reported 15 of 22 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. HAP Choice West Michigan HMO Option 2 HAP Choice West Michigan HMO Option 2. . CVS Caremark will mail a mail service order form. Prescription drugsare often an important part of your health care. 11-A1 BIN NUMBER 009737 M Michigan Department of Community Health 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1 B2 B3 E1 M B1 Billing . 1 0 obj For more information about MDHSS Fee-for-service carve outs please click here. Members may go to an in-network pharmacy and receive up to 8 self-test kits per month. Aetna Better Health of MI members may use the following information along with the ID number to process prescriptions at network pharmacies: Pharmacy providers may go toCVS/Caremarkfor payer sheets and additional network or processing information. 24/7 access to eligibility, benefits, authorizations and more. The Pharmacy Prior Authorization form is available on our website. Michigan Medicaid hours of operation regarding Medicaid Application Michigan are Monday through Friday, from 8:30 am - 4:30pm, but the best calling hours for Michigan Medicaid to call regarding . Here is the NCPDP version D.0 Payer Sheetwith complete claims processing requirements/information for HAP Empowered Medicaid. #current year# Health Alliance Plan of Michigan. For brand name drug requests, a completed FDA MedWatch form documenting failure or issues with the generic equal is required. If you want to receive Medicaid benefits in Michigan, you will likely need to report to one of these offices. Your doctor will have to complete this form. 128 0 obj <> endobj They must include any medical records needed for the request. Insurance Name. Tools are available in alternate formats. For questions about ID cards, benefits, claims or other issues: Call the number on the back of your member ID card or 313-225-9000. That makes it easy on our members too. If you need the services below to join, please contact the MDHHS Section 1557 Coordinator 517-284-1018 (Main) TTY users call 711, 517-335-6146 (fax) MDHHS-ComplianceOffice@michigan.gov. Page Last Updated: 06/11/2019 Click herefor more information about the opioid resources provided by MDHSS including a link to a copy of a Nonopioid Directive form in your language. If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. In the past, the Medicaid recipient identification number assigned to recipients was a 13- digit number that included as a part of the number a two-digit parish code as the first and second digits of the number, and a two-digit eligibility category code as the third and fourth digits of the number. 0 The Pharmacy Prior Authorization form is available on our website. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.. The Michigan Medicaid office is an important government facility. Aetna Better Health Specialty Drugs are filled by CVS Health Specialty Pharmacy. 11 -A1 BIN NUMBER (see above) M 12 -A2 VERSION/RELEASE NUMB ER D M 13 -A3 TRANSACTION CODE B1, B3 M 14 -A4 PROCESSOR CONTROL NU MBER See above M Required for All Claims . xnFaTPQsE`$.kCZYvTV/3IiD-"ssvt\{ztZ'nol>^~<9ag#s/qf-GbT%H g+b3cOo>Flov%#v? 1199 National Benefit Fund. Is MAVYRET covered for patients on Emergency Services Only (ESO) Medicaid? We provide members with the care they need, when they need it. For information regarding CSHCS Care Management, please call 616.464.8221 or email cshcs@priorityhealth.com. 2 0 obj Home About Us Contact Us Careers. The Insurance Payer ID is a unique identification number assigned to each insurance company. For patients currently taking another Direct-Acting Antiviral (DAA) therapy (Zepatier, Epclusa, etc. Call CVS Caremark, toll free at 1-800-552-8159/TTY 711, Monday to Friday between 8 a.m. and 8 p.m., for help to sign up for mail order service. Y:1~eXXXw1Cf~2 7j; hb``e``jd```, p. Medicaid Online To view the website for Michigan Medicaid online, click here. They must show why a formulary drug will not work for you. There are no co-pays for viral hepatitis treatments for Healthy Michigan Plan. Network pharmacies have also been made aware of the changes to the PA status of Mavyret and should be prepared to dispense accordingly. Visit the State of Michigan website for more information on CSHCS and eligibility. The preferred Glucose meters and Test Strips are J&J One Touch products. If you receive both Medicare and Michigan Medicaid, we can coordinate your care and help you get healthier. Use one of the following to request this service: MDHHS is partnering Aetna Better Health in the We Treat HEP C Initiative. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. %%EOF Pharmacy Billing Information. vP3q ~xB=`aS0mijps252 C#*mU$LY9g#!qEV:?K`%3}(AIm-:.`P)Ppm!B[JU >+8qm$~.u|pIoFT*!mArl3_'S3x. Michigan Medicaid number where you can call and speak to Michigan state health care agent regarding Medicaid Application Michigan is 1-888-367-6557. 11-A1 BIN NUMBER (see above) M 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1, B3 M 14-A4 PROCESSOR . Commercial and Medicaid BIN: 610494 PCN: 9999 Community Health BIN: 610613 PCN: 2417 ProAct BIN: 017366 PCN: 9999 FlexScripts/ProAct BIN: 018141 PCN: 9999 United Healthcare Community Plan of Indiana BIN: 610494 PCN: 4841 . Payer Id.
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