This plan is available to anyone who has both Medical Assistance from the State and Medicare. Certain drugs on the Aetna Better Health of Michigan formulary have quantity limits and are listed on the formulary with QLL. 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. The Insurance Payer ID is a unique identification number assigned to each insurance company. TTY Toll-Free: 800-877-8339. Toll-Free: 877-267-2323. TTY Local: 410-786-0727. endobj hb``e``jd```, You are now leaving Aetna Better Health of Michigans website. HAP Choice West Michigan HMO Option 1 HAP Choice West Michigan HMO Option 1. For Medicaid, co-pay for MAVYRET is $1, and co-pay for non-preferred DAAs are $3. 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. p#*_.Iu/37Z* f(Yvz((j We help Medicaid members get the health care they need in 32 Michigan counties across the state. Commercial and Medicaid BIN: 610494 PCN: 9999 COMMUNITY HEALTH BIN 610613 PCN: 2417 Maryland Medicaid BIN: 610084 PCN RXSOLPRD ProAct BIN 017366 PCN: 9999 . Updates to the PDL/Common Formulary can be found online using the formulary documents linked below: MDHSS carves out specific classes of drugs. p. MAVYRET is covered for beneficiaries on Emergency Service (ESO) Medicaid. These drugs are covered by MDHSS Fee-or-service (FFS) using the Magellan Pharmacy Benefit Manager. Is MAVYRET covered for patients on Emergency Services Only (ESO) Medicaid? Aetna Better Health of Michigan covers prescription drugs and certain over the counter drugs when presented with a prescription at a pharmacy. Medicaid Online To view the website for Michigan Medicaid online, click here. If you receive both Medicare and Michigan Medicaid, we can coordinate your care and help you get healthier. Copyright document.write(new Date().getFullYear()) Aetna Better Health of Michigan, All Rights Reserved. 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 . Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. The UPHP wants to help keep you and your family healthy. 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. 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 . What is the co-pay for MAVYRET under this agreement? Pharmacy Billing Information. 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*). Reasons to choose Priority Health. GROUP: RX8826. Aetna Better Health of Michigan offers mail order prescription services through CVS Caremark. wwx$AZS@NJ7B>a '2"adi=#IP$he[@HH*[sM'#(@7%}1JJI#Sdi9q Meridian Health Plan 004336 MCAIDADV RX5492 Molina Healthcare of Michigan 004336 ADV RX0506 Priority Health Choice 003858 MA PHMEDCD United HealthCare Community Plan, Inc. 610494 4242 ACUMI Upper Peninsula . R\J=lSkSeD!LOx[{Xp7M?tOF~~x,O:JX t The preferred pen needles are BD. 2 0 obj Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. The Specialty Drug Program has special services for you: You can contact CVS Specialty Pharmacy at1-800-237-2767; TTY/TDD:1-800-863-5488from 7:30 a.m. (EST) to 9:00 p.m. (EST) time, Monday Friday. Non-preferred DAAs will require a PA explaining why MAVYRET is not clinically appropriate: MIRx_PAfaxform_General.pdf (magellanrx.com). We provide members with the care they need, when they need it. To find out it if a drug that you take is covered, you can check the MDHSS PDL and Common Formulary for the most current coverage status. If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. xnFaTPQsE`$.kCZYvTV/3IiD-"ssvt\{ztZ'nol>^~<9ag#s/qf-GbT%H g+b3cOo>Flov%#v? m~@tR8r!#d'$G!rS`.&#Tv5mu1@[AwasrWLeRK6Z6ev &oVV[]yQ5JGqj,&}6"aewDt*&I=g{`NMh3_:%8[7u{89t,3krmrr+ A Specialty pharmacy fills drugs but has other services to help you. 11-A1 BIN NUMBER (see above) M 12-A2 VERSION/RELEASE NUMBER D M 13-A3 TRANSACTION CODE B1, B3 M 14-A4 PROCESSOR . They must show why a formulary drug will not work for you. 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. Medicaid.gov Mailbox: Medicaid.gov@cms.hhs.gov. U?o=3(0 CVS Specialty Pharmacy will assist you in filling your specialty drug. The Michigan Medicaid office is an important government facility. 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. The Pharmacy should indicate level of service 3 (emergency) on the claim. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648 Hep C treatment no longer requires a prior authorization if using the State Preferred PDL agent Mavyret. 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.. Last Updated: 03/31/2022. When the member receives the form, the member fills it out and mails CVS Caremark the prescription and the order form. 1-888-417-3479 4 0 obj <> A formulary is a list of drugs that Aetna Better Health covers and the formulary consists of the MDHSS PDL and Common Formulary. 0FY( 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. Get the latest information about COVID-19, the vaccine and PHE wind down. %PDF-1.7 By requesting your doctor to write a prescription for a 90-day supply with up to one year of refills. 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? Your doctor will have to complete this form. This is especially true if you choose to apply for benefits in person at an acceptance facility. 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. 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. 24/7 access to eligibility, benefits, authorizations and more. Limitations, co-payments, and restrictions may apply. Will there be specific PA criteria listed in the PDL for the non-preferred DAAs? 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 . 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. For confirmation of carved out agents use the FFS drug search tool. Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. Here is the NCPDP version D.0 Payer Sheetwith complete claims processing requirements/information for HAP Empowered Medicaid. Pharmacies are authorized to dispense up to 102 days of therapy at a single time. Michigan Medicaid number where you can call and speak to Michigan state health care agent regarding Medicaid Application Michigan is 1-888-367-6557. endstream endobj startxref 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. HAP Choice West Michigan HMO Option 2 HAP Choice West Michigan HMO Option 2. . 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. This information may include the following: Both parties will be told of the decision through the telephone or mail. &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!^ Pharmacy providers may go to CVS/Caremark for payer sheets and additional network or processing information. 1st Medical Network - Atlanta GA. H0192_001_WEB_1494050. When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium. HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. vP3q ~xB=`aS0mijps252 C#*mU$LY9g#!qEV:?K`%3}(AIm-:.`P)Ppm!B[JU >+8qm$~.u|pIoFT*!mArl3_'S3x. If a drug is not listed on the formulary, a Pharmacy Prior Authorization Request form must be completed. CVS Caremark will call the prescribing provider to get the prescription with the members ok. Log in and sign up for mail service online. 1199 National Benefit Fund. PCN: ADV. Visit the State of Michigan website for more information on CSHCS and eligibility. 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. Providers Providers homepage Coronavirus (COVID-19) Prescription drug coverage determination. You may also request a printed copy of this formulary by calling Member Services. 6Q~otUs9("+r_iJ s-l["XP (QSwRWPN4Z1& &>Soy^LEOX1aL5`h!&9{Q]N0p Medicaid Health Plan BIN PCN Group Aetna Better Health of Michigan 610591 ADV RX8826 Blue Cross Complete of Michigan 600428 06210000 n/a . 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 Medicaid Drug Rebate Program Labeler List Reference - To help you more easily identify Medicaid rebatable NDCs, we are posting a monthly reference list here. endobj HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. 31147. 1 0 obj 128 0 obj <> endobj #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. These counts do not include the Consumer Assessment of Healthcare . stream Our portals will be unavailable during this period. Tools are available in alternate formats. (800) 888-9885 (TTY: 711) MondayFriday, 8 am to 8 pm. 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. Home About Us Contact Us Careers. This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. Baltimore, Maryland 21244-1850. Contact UPHP by emailing the Customer Service Department or by calling 1-800-835-2556. 13162. All MDHHS registered prescribers, including non-specialists, will be able to prescribe Mavyret as of 4/1/2021. 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. The specialty drug list is availablehere. endobj Contact UPHP by emailing the Customer Service Departmentor by calling 1-800-835-2556. 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 . #current year# Health Alliance Plan of Michigan. %%EOF That makes it easy on our members too. What is the co-pay for a non-preferred DAA? Network pharmacies have also been made aware of the changes to the PA status of Mavyret and should be prepared to dispense accordingly. The Pharmacy Prior Authorization form is available on our website. They must include any medical records needed for the request. %PDF-1.7 % People 65 and older with Medicaid may also be eligible for a Dual Eligible Special Needs Plan, or D-SNP. 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 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.
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