2022 CVS Caremark Provider Manual Supplement for 2023

Section 2.06 Change in Ownership

• Buyers must satisfy any outstanding audit amounts associated with either the buyer or the seller prior to initiating change in ownership enrollment process

Section 3.03.03 Coupons and Other Programs

• There are two additional coupon types that are specifically disallowed by Caremark (Alpha Scrip, SimpleSaveRx)

Section 5.06 Prior Authorization

• Pharmacies may not “act on behalf of a Prescriber or member of Prescriber’s staff” as part of the prior authorization process

Section 8.05 Supply of Covered Items; Purchases Invoices (previously distributed May 2022)

• Caremark outlines their “bulk purchase notification” requirements including the allowance to notify up to 21 days after the bulk purchase and to notify by email

Appendix C – Appeals Process Documentation Guidelines

• Caremark has emphasized that documentation submitted should be relevant
• Various changes to acceptable documentation descriptions, most of which simply provide more clarity
• Copay (CPY) discrepancy spells out additional details with respect to cash copays
• Drug invoice shortage (DIS) discrepancy spells out additional details with respect to proof of payment for inventory
• No signature log (NSL) discrepancy spells out additional details for medications delivered by carrier other than a pharmacy employee

PAAS Tips:

• Please contact PAAS National^® (608) 873-1342 or info@paasnational.com, as soon as possible when you are notified of an audit – the sooner that we are part of your team, the more benefit we can bring