Fax Coversheet - PBA Health
Iowa Medicaid: IA Health Link
Effective April 1, 2016
Effective April 1, 2016, the Iowa Department of Human Services (DHS) will be transitioning most Iowa Medicaid members to a new managed care program, called IA Health Link. This program will be administered by three contracted managed care organizations (MCOs), Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc. and United Healthcare Plan of the River Valley, Inc.
|Managed Care Plan |PBM |
|Amerigroup Iowa |Express Scripts |
|AmeriHealth Caritas Iowa |PerformRx |
|United Healthcare Plan of the River Valley |OptumRx* |
*TriNet pharmacies are independently contracted with OptumRx
Express Scripts: Amerigroup Iowa
Express Scripts is the pharmacy benefits manager for Amerigroup. If a member does not have an ID card, please call Amerigroup at 1.800.454.3730 to verify eligibility. For Amerigroup members, submit claims to Express Scripts using the following BIN/PCN/Group combination:
|BIN |003858 |
|PCN |MA |
|Group |WKGA |
Prescriber NPI Requirement: The prescribers’ NPI must be submitted. Claims submitted without the prescriber’s NPI, with an invalid or inactive NPI, or those submitted with other types of prescriber IDs will reject with code 25 (Missing or Invalid Prescriber ID).
Copayments: Members do not have a copayment.
Days’ Supply: Pharmacies may fill up to a 31-day supply except for contraceptives, which are filled for a 90-day supply. Some medications have a 15-day initial supply limit.
Drug Coverage: Members must use generics when available, but some brand name drugs are preferred over their generic equivalents.
Transition of Care Benefit: Members may receive temporary transitional fills of some medications, identified by secondary messages on paid claims stating “Paid under Transition Fill.”
COB Information: Follow the OPAP formula for Amerigroup Community Care member claims.
For more information on pharmacy services, please visit ia/your-plan/iowa-medicaid.html .
For questions regarding pharmacy services, providers may contact Express Scripts:
Express Scripts Pharmacy Help Desk: 1.855.690.8353
Eligibility Verification: 1.800.454.3730
Prior Authorization Requests: 1.855.712.0104
PerformRx: AmeriHealth Caritas Iowa
PerformRx is the pharmacy benefits manager for AmeriHealth Caritas Iowa. If a member does not have an ID card, please call AmeriHealth Caritas Iowa at 1.855.328.1612 to verify eligibility. For AmeriHealth Caritas Iowa members, submit claims using the following BIN/PCN/Group combination:
|BIN |600428 |
|PCN |07390000 |
|Group |varies |
Copays: There will be no prescription copay for members who are younger than 21 years old, pregnant or receiving emergency services.
Prescription benefits: AmeriHealth Caritas Iowa covers medicines that are medically necessary, approved by the Food and Drug Administration (FDA), prescribed by a doctor
Preferred drug list (list of medicines): AmeriHealth Caritas Iowa uses the Iowa Medicaid Enterprise (IME) drug formulary.
Over-the-counter medicines: With a prescription, AmeriHealth Caritas my cover over-the-counter medicines.
Prior authorization: Some medicines on the Iowa Medicaid Enterprise (IME) drug formulary and all medicines not on the list need prior authorization.
Emergency supply: Pharmacies can give AmeriHealth Caritas Iowa members a 3-day emergency supply.
15-day initial supply: Members may only get a 15-day supply.
For more information on pharmacy services, please visit .
For questions regarding pharmacy services, providers may contact PerformRx Iowa Providers Services at 1-855-328-1612
OptumRx: United Healthcare Plan of the River Valley
For more information on the provision of pharmacy services, please visit
For questions regarding pharmacy services, providers may contact United Health Care Community Plan at 888-650-3462
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March 30, 2016
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