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As previously announced on the Provider Resource Center, effective Sept. 11, 2018, Express Scripts®, the company that processes Highmark drug claims, implemented state prescriptive authority logic within their pharmacy claim processing system.
This implementation is phase one of the three-phased initiative that will ensure all applicable Highmark regions, as well as all states, are in compliance with Federal law and applying specific prescriptive state authority.
Effective Sept. 11, 2018, if the prescriber does not meet the criteria determined by state law regarding assignment of correct taxonomy code(s) to their National Provider Identifier (NPI), Express Scripts will leverage the National Council for Prescription Drug Programs state-level prescriptive authority rejection reason code, 876.
This implementation also may mean that your patient’s prescription will not be filled at the pharmacy if your NPI is not within compliant taxonomy code requirements.
If you haven’t yet done so, Highmark recommends you review and, if necessary, update taxonomy codes assigned to your NPI. Highmark also suggests you review this information annually and make updates as frequently as required.
Express Scripts Prescriber Taxonomy FAQ 
is included for your convenience. This comprehensive FAQ summarizes the compliance logic of this implementation and includes instructions regarding how to update taxonomy codes assigned to prescribers’ NPI(s), if required.
This FAQ is available on the Provider Resource Center under Pharmacy Program/Formularies > Pharmacy Information.
