0 You are now leaving Aetna Better Health of Michigans website. 7')<7hm?O-8~h*we/x_']\F_A)R6O CB{pB/-jXkthNb. 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. People 65 and older with Medicaid may also be eligible for a Dual Eligible Special Needs Plan, or D-SNP. You may also request a printed copy of this formulary by calling Member Services. 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 The preferred Glucose meters and Test Strips are J&J One Touch products. Use one of the following to request this service: MDHHS is partnering Aetna Better Health in the We Treat HEP C Initiative. CVS Caremark will mail a mail service order form. ), will they be able to complete their course of therapy (i.e., refills)? 31147. By requesting your doctor to write a prescription for a 90-day supply with up to one year of refills. 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. Learn More. 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. Tools are available in alternate formats. Aetna Better Health of Michigan offers mail order prescription services through CVS Caremark. p#*_.Iu/37Z* f(Yvz((j 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. 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 . You are leaving our website and going to a non Medicare-Medicaid Plan website. %PDF-1.7 What has to be submitted with a MAVYRET claim now that no PA is required? Non-preferred DAAs will require a PA explaining why MAVYRET is not clinically appropriate: MIRx_PAfaxform_General.pdf (magellanrx.com). (800) 888-9885 (TTY: 711) MondayFriday, 8 am to 8 pm. 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 . R\J=lSkSeD!LOx[{Xp7M?tOF~~x,O:JX t HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. 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. Medicaid Drug Rebate Program Labeler List Reference - To help you more easily identify Medicaid rebatable NDCs, we are posting a monthly reference list here. Regardless, it is important that you understand how the Michigan Medicaid . The preferred Glucose meters and Test Strips are J&J One Touch products. 1st Medical Network - Atlanta GA. 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 MAVYRET under this agreement? If you are having trouble using UPHP materials or tools due to vision or hearing needs, please let us know. Learn more about PriorityMedicare D-SNP SM. vP3q ~xB=`aS0mijps252 C#*mU$LY9g#!qEV:?K`%3}(AIm-:.`P)Ppm!B[JU >+8qm$~.u|pIoFT*!mArl3_'S3x. Limitations, co-payments, and restrictions may apply. Aetna Better Health Specialty Drugs are filled by CVS Health Specialty Pharmacy. wwx$AZS@NJ7B>a '2"adi=#IP$he[@HH*[sM'#(@7%}1JJI#Sdi9q If you want to receive Medicaid benefits in Michigan, you will likely need to report to one of these offices. As an Aetna Better Health of Michigan member, you have the right to certain prescription drug benefits. Forms should be mailed to: Which type of provider may prescribe Mavyret? 2 0 obj hb``e``jd```, 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. For confirmation of carved out agents use the FFS drug search tool. However, many pharmacies may default to dispensing in 4-week increments, unless the script specifies an 8- or 12-week supply. H0192_001_WEB_1494050. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Your doctor will complete this form. 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*). 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. %PDF-1.7 % 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. 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. 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. endobj 3 0 obj Provide free aids and services to people with disabilities with communicate with us, such as: Qualified sign language interpreters 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. Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. Contact information For more information or assistance regarding Care Management, please contact Customer Service at 888.975.8102. This includes a wide range of benefits, such as transportation services, a 24-hour nurse help line, vision, hearing and dental coverage. 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 . The Pharmacy should indicate level of service 3 (emergency) on the claim. Pharmacy Billing Information. ;Q%8UbZD@;CKw1R+hsE3Uhe[Kmb0ey2se,3 Aetna Better Health of Michigans pharmacy prior authorization (PA) process is designed to approve drugs that are medically needed. Visit the State of Michigan website for more information on CSHCS and eligibility. #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. Local: 410-786-3000. All MDHHS registered prescribers, including non-specialists, will be able to prescribe Mavyret as of 4/1/2021. <> Certain drugs on the Aetna Better Health of Michigan formulary have quantity limits and are listed on the formulary with QLL. The UPHP wants to help keep you and your family healthy. 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. Your doctor may make a request by telephone at 1-866-316-3784, via fax 1-855-799-2551, or through CoverMyMeds.com. For patients currently taking another Direct-Acting Antiviral (DAA) therapy (Zepatier, Epclusa, etc. m~@tR8r!#d'$G!rS`.&#Tv5mu1@[AwasrWLeRK6Z6ev &oVV[]yQ5JGqj,&}6"aewDt*&I=g{`NMh3_:%8[7u{89t,3krmrr+ 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. 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. Commercial and Medicaid BIN: 610494 PCN: 9999 COMMUNITY HEALTH BIN 610613 PCN: 2417 Maryland Medicaid BIN: 610084 PCN RXSOLPRD ProAct BIN 017366 PCN: 9999 . This plan is available to anyone who has both Medical Assistance from the State and Medicare. 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. Yes. Aetna Better Health of Michigan covers prescription drugs and certain over the counter drugs when presented with a prescription at a pharmacy. HAP Empowered has a unique set of BIN/PCN numbers for processing Medicaid pharmacy claims. For more information on which test kits are covered, please clickhere. 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. hbbd```b``Sd5d`YML^?'l0yH2>HW4$21@ y0 The Michigan Medicaid office is an important government facility. For Medicaid, co-pay for MAVYRET is $1, and co-pay for non-preferred DAAs are $3. For information regarding CSHCS Care Management, please call 616.464.8221 or email cshcs@priorityhealth.com. Y:1~eXXXw1Cf~2 7j; <>/Metadata 7920 0 R/ViewerPreferences 7921 0 R>> 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 . GROUP: RX8826. TTY Toll-Free: 800-877-8339. 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 . 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. The Pharmacy Prior Authorization form is available on our website. G-3245 Beecher Road Flint, MI 48532 Phone: (888) 327-0671 TTY: 711 Fax: (833) 540-8648

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