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Emergency Refills 2017

September 8, 2017

This notice is PAI’s standard procedure and is being shared for EMERGENCY Preparedness.

With the threat of Hurricane Irma impacting the Southeast in the coming days, we are busy preparing to ensure that members’ access to their prescription medications remains uninterrupted. As a result, we are working with our PBM vendor, CVS Caremark, to implement emergency procedures to allow members to have their prescriptions filled should they be impacted by the impending storm. CVS Caremark is an independent company that provides pharmacy benefit management services for PAI.

This process will remain in effect until September 30, 2017, unless it is determined that the process should be terminated or extended based on need.

  • All network pharmacies will be able to assist members with a 30-day override for retail, mail and specialty prescriptions.
  • Pharmacies will be able to override Refill Too Soon and DUR edits at the POS by entering the code “SCC13”. This code will NOT work to override PA, Step, or Quantity Limit overrides.
  • Overrides for PA, Step, Quantity limit edits (new or renewal) will be allowed via the following procedures:

 

Pharmacists Members

Call the Caremark pharmacy Help Desk at 800-364-6331. 

The Caremark Help Desk will enter the override.

Call the Customer Service number on the back of the member ID card. Customer service can either follow their usual process for entering overrides or contact the Caremark account team to enter the override, whichever offers the fastest resolution.

 

The Caremark Help Desk and our Customer Service areas have been instructed to allow a 30-day override. Caremark Help Desks are available 24 hours a day, 7 days a week.

  • Controlled substance overrides will be allowed for up to the max allowed by the member’s benefit, not to exceed a 30-day supply. NOTE: it will be up to the individual pharmacies to determine if they will fill/refill control substance prescriptions based on regulatory/controlled substances laws.