To ensure management of non-compliant members, such members are restricted to receiving services only from authorized providers they select. Authorized providers may include a PCP, pharmacy, and specialist as needed. Providers who agree to manage restricted members will be contacted before locking in a member to that provider.
Designated pharmacies will be responsible to ensure that the member receives plan benefits only for those federal legend drugs prescribed by the PCP. If a restricted member attempts to obtain non-emergency prescription drugs at a pharmacy other than his/her designated pharmacy the non-designated pharmacy will receive a denial message PHARMACY NOT ELIGIBLE FOR PAYMENT ON DATE FILLED or PHARMACY INVALID ON FILL DATE when a claim is transmitted through the point-of-service system.
If one of the above messages appears, direct the patient to his or her assigned pharmacy.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |