News

Seasonal Preventive Flu Vaccines Members with PAI pharmacy benefit coverage with OptumRx can get flu vaccines covered under their pharmacy benefit at any in-network pharmacy. Flu vaccines administered by network pharmacies are subject to an administration fee that will be the group’s responsibility. Members are responsible for the full cost of the vaccine administered in out-of-network pharmacies.

To support appropriate utilization management, we continually review relevant clinical guidelines and reassess our requirements. Utilization management criteria for Freestyle and Dexcom CGMs will be updated for some of our formularies effective September 11, 2023.

Members with PAI’s pharmacy benefit coverage with OptumRx, we will be adding Hadlima and Adalimumab-adaz—biosimilar options for Humira

Members with PAI pharmacy benefit coverage with OptumRx that use the Lowest Net Cost (LNC) Formulary will have pharmacy changes effective October 1, 2023.

The federal government confirmed May 11, 2023, as the end of the COVID-19 public health emergency (PHE). Our Pharmacy Benefit Manager (PBM) Optum Rx has been planning for this change and reviewing recent guidance from the government agencies on how

Earlier this month, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announces that the Notifications of Enforcement Discretion issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and

CMS has released updated RxDC Reporting Instructions for the 2022 Reference Year. These updated instructions will apply to the 2022 calendar year reporting, due June 1, 2023. According to the updated instructions document, the most significant

At the beginning of this year, we partnered with Proactive MD to launch Proactive Total Care, a new type of Direct Primary Care health plan. Designed to optimize employee population health and impact total cost of care, this partnership pairs PAI’s

TCCBA.com is now redirecting to PAIsc.com. If you need historical claims information, you can still visit the secure portal for claims filed with TCC. Contact us if you have any questions.

On December 29, 2022, the Continuing Appropriations Act, 2023 (CAA 2023) was enacted. In addition to other measures, this law includes a two-year extension of telehealth coverage flexibility for HSA compliant high deductible health plans. This is the