Provider Remittance Advices
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1 ene, 2022

Pharmacy mail order vendor change effective 1 de enero de 2022 (Commercial only)

Non-specialty pharmacy

A new preferred home delivery pharmacy and/or a new option for certain members’ maintenance medication needs is being changed from Alliance to Express Scripts Pharmacy®.

 

Existing, non-expired maintenance medication prescriptions for patients in commercial plans were automatically transferred to Express Scripts as of 1 de enero de 2022. Any open prior authorizations for drugs continuing to be covered on the formulary will be carried over to Express Scripts. After 1 de enero de 2022, you will need to send any new prescriptions to Express Scripts if these patients want to continue to use a home delivery service.

 

Some prescriptions will not be automatically moved, and you will need to send a new prescription to Express Scripts on or after 1 de enero de 2022. Incluyen:

  • Controlled substances
  • Medicines regulated by a risk evaluation and mitigation strategy (REMS) program
  • Prescriptions that expired before 1 de enero de 2022
  • Prescriptions that have no refills left as of 1 de enero de 2022
  • New prescriptions that have not been filled at AllianceRx Walgreens Prime

 

Prescriptions can easily be sent to Express Scripts Pharmacy using your EMR system by e-prescribing to Express Scripts Home Delivery. For questions on e-prescribing call 1-800-211-1456, option 5. For more information, visit https://www.express-scripts.com/rx.

 

If you have any questions, please call the Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050 for out-of-state providers.

 

Specialty pharmacy

A new preferred home delivery pharmacy and/or a new option for certain members’ maintenance medication needs is being changed for specialty pharmacy from Alliance to Accredo. There is no immediate action you need to take. Existing, non-expired prescriptions were automatically transferred to Accredo as of 1 de enero de 2022. Any open prior authorizations for drugs continuing to be covered on the formulary will be carried over to Accredo. After 1 de enero de 2022, you will need to send new specialty prescriptions for these patients to Accredo.*

Some prescriptions will not be automatically moved, and you will need to send a new prescription to Accredo on or after 1 de enero de 2022. Incluyen:

  • Controlled substances
  • Medicines regulated by a risk evaluation and mitigation strategy (REMS) program
  • Prescriptions that expired before 1 de enero de 2022
  • Prescriptions that have no refills left as of 1 de enero de 2022
  • New prescriptions that have not been filled at AllianceRx Walgreens Prime

 

Fertility

Care New England Pharmacy and Freedom Fertility Pharmacy (referenced as Accredo in member letters) will be the new pharmacy options available for fertility drugs. (The current provider for fertility drugs is Village Pharmacy.)

Accredo provides your patients access to their specialty medications and dedicated clinical resources to help them manage their health condition(s). Accredo has various tools available to you, including physician concierge, e-prescribe, ePA, and interoperability with EHRs. Once these patients are live with Accredo, you will have visibility to their status through Accredo’s provider portal at https://myAccredoPatients.com. For more information, visit https://www.accredo.com/prescribers.

If you have any questions, please call the Physician & Provider Service Center at (401) 274-4848 or 1-800-230-9050 for out-of-state providers.

 

*with the changes being made from Walgreens to Accredo, Accredo will not be contacting the prescribing provider for the prescription. It will be the providers responsibility to send over the prescription to Accredo once your determination letter is received from Prime*

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