Pending CMS Approval
PartnershipAdvantage (HMO SNP) - Prescription Drug Benefit (Part D) 2013
Medicare Part D Formulary
Click here - to view the PartnershipAdvantage Formulary (Medicare Part D) - 2013 - (H5782 PHC_1085_13CF_001 CMS Accepted)
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) 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 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.WalgreensHealth.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: Description of Services
Medication Therapy Management Program
Partnership HealthPlan of California contracts with OutcomesMTM™ to offer Medication Therapy Management services to all PartnershipAdvantage members. Through OutcomesMTM, specially trained Personal Pharmacists are identified in communities throughout Northern California.
These pharmacists do much more than dispense drugs. They are there to help you get the best results from your medication while keeping out-of-pocket costs down. By using an OutcomesMTM Pharmacist, you can get the extra attention you need to keep your medications on the right track.
As a PartnershipAdvantage member, you are eligible for these important services at no additional cost. Services available include:
Comprehensive Medication Review: Your OutcomesMTM Pharmacist will meet with you to review all your medications. This will help identify any duplications or conflicts and help organize your medication
schedule.
Prescriber Consult: Your OutcomesMTM Pharmacist will confer with you and your doctor(s) to resolve any
problems found with your medications.
Drug Information: When starting with a new medication, your OutcomesMTM Pharmacist will:
- Talk to you about its purpose and correct use.
- Follow-up to make sure the drug is working right and your not having any problems.
Getting started is easy. Simply call the Member Services line at (866)264-3626 or TTY line at (800)735-2929. Ask about the locations of OutcomesMTM Pharmacists in your area.
Frequently Asked Questions:
Where can I find an OutcomesMTM Pharmacist?
- Call the Member Service line at (866)264-3626 or TTY line at (800)735-2929. Ask about OutcomesMTM Pharmacists in your area.
Are all pharmacists in the PartnershipAdvantage network also OutcomesMTM Pharmacists?
- Not all pharmacists in the PartnershipAdvantage network are OutcomesMTM Pharmacists. OutcomesMTM Pharmacists have finished a special training course to provide these extra services. This course is open to any pharmacist. Ask your regular pharmacist if they participate.
Can I use my regular pharmacy and still visit OutcomesMTM Pharmacist too?
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Yes. Your OutcomesMTM Pharmacist is an added value of membership. You may continue to use any PartnershipAdvantage participating pharmacy for your prescriptions.
Will I pay additional costs for using an OutcomesMTM Pharmacist?
- No. These services are offered at no additional cost.
Do I need an OutcomesMTM Pharmacist to save me money?
- Yes. Similar medications can have large cost differences. Your OutcomesMTM Pharmacist can help you take the least costly, most highly effective medications.
Will my doctor know if any changes need to be made to my prescriptions?
- Yes. Your OutcomesMTM Pharmacist may make recommendations to you and your doctor(s) - but only your doctor can change your prescription.
Will I be required to use an OutcomesMTM Pharmacist?
- No. Your OutcomesMTM Pharmacist is an added service of membership. They are there to help, but you are not required to use them.
How do I get started?
- Contact an OutcomesMTM Pharmacist in your area to schedule your Comprehensive Medication Review.
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