ACTOS®-- Effective January 1, 2009, all new prescriptions for pioglitazone (Actos®) will be denied at the point of sale unless the cardholder’s PACE claim’s history contains claims for metformin, a sulfonylurea or insulin within the last 60 days. As with Avandia®, NO provider requested medical exceptions will be granted. Following this denial, a letter will be sent to the prescriber identified on the claim requesting documentation supporting the prescribing of Actos®. Upon receipt of this documentation, consideration of a medical exception will be made.
Date Prescription Written: Currently the date a prescription is dispensed cannot exceed six (6) months from the Date the Prescription is Written. Claims exceeding this limit are currently identified on remittance advices with an EOB “M/I Date Prescription Written” (PACE 742; NCPDP 28). Effective Tuesday November 4, 2008, claims dispensed more than 12 months from the date the prescription is written will deny with PACE Error 742; NCPDP Error 28.
Questions may be directed to Provider Services at: