PartnershipAdvantage (HMO) - Prescription Drug Benefit (Part D) 2010
Medicare Part D Formulary
Click here to view the PartnershipAdvantage (HMO) Formulary (Medicare Part D) - 2010
(Approved – 10/05/2009) and more information about the formulary.
Changes to Medicare Part D formulary
Click here to view information regarding changes to the Medicare Part D Formulary.
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Pharmacies
We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. Please click here to view our Pharmacy/Provider Directories.
When you fill your prescriptions at our network pharmacies, the total cost of your Part D drugs (paid by PartnershipAdvantage (HMO)) will be tracked. You will receive a statement by mail call the "Explanation of Benefits". It will list all Part D transactions from the previous month and display what you have spent if any and what your total drug costs are year to date.
PartnershipAdvantage (HMO) has contracts with pharmacies that equals or exceeds CMS requirements for pharmacy access in your area.
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Out-of-network pharmacy coverage
Generally, we only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. In this situation you may have to pay the full cost when you fill your prescription. Before you fill a prescription at an out-of-network pharmacy, please call Member Service to see if there is a network pharmacy available. For more information about what situations we will cover prescriptions that are filled at out-of-network pharmacy and how to file a claim, please refer to the Disclosure Form and Evidence of Coverage.
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Mail order services
You can use our Plan's network mail-order pharmacy service to fill prescriptions for what we call "mail order drugs" / "maintenance drugs". These are drugs that you take on a regular basis, for a chronic or long-term medical condition. Maintenance medications are those medicines that are taken regularly for medical conditions like high blood pressure, diabetes and high cholesterol. This does not include allergy medications such as antihistamines, antibiotics or medications for pain.
To set up mail order services call Walgreen's at 1-800-635-3070 or register through their web site at www.walgreensmail.com.
You are not required to use our mail order services to get an extended supply of maintenance medications. You can also obtain an extended supply through some retail network pharmacies.
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Medication Therapy Management program and drug utilization management
We offer medication therapy management programs at no additional cost for members who have multiple medical conditions, who are taking many prescription drugs, or who have high drug costs. These programs were developed for us by a team of pharmacists and doctors. We use these medication therapy management programs to help us provide better coverage for our members. For example, these programs help us make sure that our members are using appropriate drugs to treat their medical conditions and help us identify possible medication errors.
We offer the medication therapy management program(s) to members that meet specific criteria. We may contact members who qualify for these programs. If we contact you, we hope you will join so that we can help you manage your medications. Remember, you do not need to pay anything extra to participate.
If you are selected to join a medication therapy management program we will send you information about the specific program, including information about how to get the program.
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