Important Update:
Mail Order/Specialty Pharmacy Statutory Changes
HealthPlus Amerigroup is aware of the recent amendments to the New York Social Services Law, effective April 1,
2013, concerning access to specialty mail order covered prescriptions.
We have continued to work with the New York Department of Health (DOH) to create processes to fully implement
the requirements of the new amendments by July 1, 2013.
Effective July 1, 2013:
● Should a HealthPlus Amerigroup member wish to receive a specialty pharmacy drug/s from an in-network
retail pharmacy rather than HealthPlus Amerigroup’s specialty vendor (CVS Caremark Specialty Pharmacy),
they may choose any pharmacy in HealthPlus Amerigroup’s retail network as long as that in-network retail
pharmacy is willing to accept comparable pricing.
●
If a member selects an in-network retail pharmacy that has not requested to be in HealthPlus Amerigroup’s
Specialty Pharmacy Network, and has not accepted comparable pricing then the in-network retail pharmacy
should still attempt to adjudicate the claim.
●
If the pharmacist is having difficulty with a claim in processing the point-of-sale transaction, they should
contact the telephone number indicated on the reject message for further processing of the point-of-sale
transaction.
Please keep in mind that anytime one of our members has any pharmacy-related questions, they may also reach
out to the Amerigroup Pharmacy Department at 1-800-454-3730.
For a complete list of our specialty drugs, please refer to the HealthPlus Amerigroup Medication formulary at
http://providers.amerigroup.com/AGP%20Documents/NYNY_CAID_HP_Formulary.pdf (specialty drugs denoted by
“X - Medication provided by Specialty Pharmacy Network”) or to the HealthPlus Amerigroup Preferred Drug List
(PDL) at https://www.myamerigroup.com/English/Documents/NYNY_CAID_PDL.pdf (specialty drugs denoted by “X
- distribution through specialty pharmacy network”).