FORMULARY AND DRUG PRICING TOOL

Medicare Prescription Drug Plans

A formulary is a list of drugs selected by Care Improvement Plus in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. The formulary consists of both generic and brand name drugs.

Care Improvement Plus will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Care Improvement Plus network pharmacy, and other plan rules are followed.

Transition Policy

For new members or members transitioning from a hospital or LTC facility, if your medication is not on the formulary you are guaranteed a transition supply for a Medicare covered medication until you and your doctor can determine if there are formulary alternatives that you can utilize or request an exception from the health plan. Our policy is described in more detail here.

The Care Improvement Plus formulary is extensive. To view a comprehensive listing of each plan's drugs, click here. (Revised 7/2010)

Extra Help (Low Income Subsidy)

You may qualify for extra help paying your monthly drug plan premium and a portion of your prescription drug costs – and even prescription drug coverage through the coverage gap.

Extra help is provided by Medicare to pay prescription drug costs for people who meet specific income and resource limits. Resources include your savings and stocks, but not your home or car. If you qualify, you will get help paying for your Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. In most cases, if you get extra help, you won’t pay a premium. If you qualify for extra help, you won’t have a coverage gap either.

To see if you qualify, call: 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213 between 7:00 am and 7:00 pm, Monday through Friday, TTY/TDD users should call 1-800-325-0778; or your State Medicaid Office.

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

Monthly Plan Premium if You Get Extra Help
Click here to find out what your monthly plan premium will be if you get extra help from Medicare.

Drug Pricing Tool

Each Care Improvement Plus Plan has a drug pricing tool that was specifically designed to show beneficiaries how much their prescriptions will cost during all coverage stages (initial coverage, coverage gap – doughnut hole, and catastrophic coverage).

Search for a drug in 5 easy steps:

Click on a link
Select the beneficiary's state from the dropdown list and click Continue.
Enter drug name and click Search, or use the alphabet list of commonly prescribed medications to find a drug that begins with that letter.
Select the drug's strength...
The prices that display reflect the cost of the entered drug in all coverage stages.

Chronic Condition Special Needs Plans
Medicare/Full Medicaid Special Needs Plans
Medicare Advantage Prescription Drug Plan

Upcoming Changes to Care Improvement Plus' Formulary
Care Improvement Plus may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, add prior authorization, add quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier, we will notify you of the change at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, in which case we will immediately remove the drug from our formulary.

For information about updates that have been made to our plans' formularies, click here. (Revised 8/2010)

2010 Prior Authorization Criteria

Members will need to get prior authorization for certain drugs on our formulary. Drugs will need a prior authorization (PA) if they have a B/D and/or a PA next to them on the formulary. Members or their provider can call 1-800-753-2851 to request a prior authorization. For more information regarding the criteria for medications that have prior authorization, please click here.

To learn about your rights in requesting an exception or appeal on a medication request please fill out the following forms.

Click here to access the Medicare Prescription Drug Plan Finder. By clicking this link you are now leaving the Care Improvement Plus website.

Medication Therapy Management Program

People with very complicated medication therapy will benefit from the Care Improvement Plus Medication Therapy Management Program. This program is available at no additional cost to you. If you take five (5) or more prescription medications every day and have two (2) or more long-term health conditions and might spend more than $3,000 a year on medications, you will be automatically enrolled in this program.

Below is a list of health conditions that may make you eligible for the Medication Therapy Management Program. You need to have two or more of these conditions to qualify for this program.

Asthma
Depression
COPD
Diabetes
Hypertension
Heart Failure
Osteoporosis
High Cholesterol
End Stage Kidney disease requiring dialysis

Contact Member Services at: 1-800-204-1002 (TTY users, please call: 1-800-713-1603) to get more information regarding the Medication Therapy Management Program.

Part D Vaccine

If you have been prescribed a vaccine that is covered under Medicare and was administered by your physician, your physician may submit the claim to Medco for reimbursement and collect only your copay by submitting the Vaccine Claim form to:

Medco Health Solutions, Inc.
PO BOX 14718
Lexington, KY 40512

Upon receipt of the HCFA 1500 from the physician, Medco will process the paper claim and return reimbursement to the physician's office with an explanation of payment including the beneficiary's cost share for collection.

Mail Order

For obtaining prescription drugs by mail, use the following Mail Order Form, and include a completed Health, Allergy, and Medication Questionnaire.

As a Care Improvement Plus member, you may request:
Additional information from the Centers for Medicare and Medicaid Services by calling 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), which is the national Medicare help line, 24 hours a day, 7 days a week.
The aggregate number of Care Improvement Plus grievances, appeals and exceptions, by calling Member Services.

This page was last updated on: 7/30/2010 2:54:15 PM