This page provides pharmacy-related safety alerts, drug recall and new generic drug announcements and other medication information.
Humana made changes that took effect Jan. 1, 2017.
Effective Jan. 1, 2017, Humana Pharmacy Solutions implemented additional utilization management tools in its opioid utilization program that will result in point-of-sale edits. The edits will be based on opioid thresholds.
Effective Jan. 1, 2017, compounded medications utilizing an oral formulation of certain ingredients will be considered nonformulary and require an exception before Medicare members can fill under their Part D benefits.
Effective Oct. 11, 2016, Argus will reject transactions submitted with a decimal in the diagnosis code field (434-DO), as well as those submitted with lowercase letters in an alphanumeric field.
In accordance with Louisiana House Bill 436, pharmacies may be eligible for refund of 10 cents per claim where a fee was previously applied.
Effective Sept. 1, 2016, certain Humana Medicaid pharmacy claims will be returned with NCPDP reject code 77: Discontinued Product/Service ID Number.
Humana will reimburse network pharmacies for providing influenza and pneumococcal vaccinations to Humana Medicare Advantage (MA), Medicare Advantage-Prescription Drug (MAPD) and Humana commercial members.
Effective Jan. 1, 2017, certain drugs in the Humana Medicare formularies will have new limitations or will require utilization management for the 2017 plan year.
Humana would like to remind pharmacies to monitor pharmacy claims for accuracy and comply with federal and state laws, rules and regulations when filling prescriptions and submitting claims for refills and partial fills of Schedule II drugs.
Pharmacies serving Humana Medical Plan (Medicaid) members must meet all requirements set forth in the Hernandez settlement agreement.
Humana would like to notify network pharmacies that generic Zetia (ezetimibe) will be considered noncovered/nonformulary for all Medicare, Employer Group and HumanaOne formularies.
The Centers for Medicare & Medicaid Services’ (CMS) guidelines and state Medicaid guidelines prohibit Medicare-contracted providers from collecting cost-share for Medicare-covered services, including Part B prescription services provided at point-of-sale from members who are protected by the state from cost-sharing.