2014 Express Scripts Medicare Prescription Drug Plan
Frequently Asked Questions
May I continue using the same retail pharmacy with the Medicare Prescription Drug Plan or do I have to use Express Scripts’ home delivery service?
You may fill your prescriptions at your current retail pharmacy as long as it is in the Express Scripts Medicare network. There are more than 68,000 pharmacies in the Express Scripts Medicare national pharmacy network. If you’re currently using a pharmacy that will not be in the Express Scripts Medicare network next year, Express Scripts will notify you prior to Jan 1, 2014.
May I get a 90-day supply of my maintenance medications?
You may receive up to a 90-day supply of certain maintenance drugs (medications taken on a long-term basis) through your network retail pharmacy or by mail through Express Scripts’ home delivery service.
Will my copayments remain the same under the Medicare Prescription Drug Plan?
Copayment amounts for generic, brand and non-formulary drugs will remain the same. In some instances, the copayment you pay for your prescription drug may change. For example, your prescription drug may be considered a non-formulary (non-preferred) under the plan in 2013 and a brand (preferred) under the Medicare Prescription Drug Plan, lowering your out-of pocket costs. Or, your prescription drug may be considered a brand under the plan in 2013 and non-formulary (non-preferred) under the Medicare Prescription Drug Plan, increasing your out-of-pocket costs. Express Scripts will notify you prior to Jan. 1, 2014 if the copayment for your prescription drug will increase under the Medicare Prescription Drug Plan.
Do I need to fill out any paperwork to be enrolled in the Medicare Prescription Drug Plan?
If you want to keep your MCHCP coverage, you don’t need to do anything before MCHCP’s Open Enrollment period. At Open Enrollment during October, you will automatically be enrolled in the Medicare Prescription Drug Plan if you enroll in the PPO 300 or PPO 600 plans and you’re a Medicare-primary member.
In the Catastrophic Coverage Stage, I’ll pay the greater of 5% coinsurance or a copayment ($2.55 for generic and $6.35 for all other drugs). Is the 5% coinsurance based on the discounted price of the drug?
Yes. The 5% coinsurance is calculated using the network discounted amount of the drug, not the full price of the drug.
The discounted cost of my drug in the Catastrophic Coverage Stage is $3,000. How much will I pay?
You will pay the applicable Initial Coverage Stage copayment because 5% coinsurance (5% of $3,000 = $150) is greater than the standard copayments during the Initial Coverage stage.
Will all of my drug costs help meet the $4,550 out-of-pocket in the Catastrophic Coverage Stage?
Only costs for Part D drugs will apply to the out-of-pocket. MCHCP has added additional drugs to the Medicare PDP formulary which may not be Part D drugs, however, are still covered with the applicable copayment.
If I enroll in the Medicare Prescription Drug Only Plan during this Open Enrollment, can I enroll in an MCHCP medical plan with prescription drug coverage next year during Open Enrollment?
Does this Medicare Prescription Drug Plan have a “donut hole” feature?
MCHCP’s Medicare Prescription Drug Plan does not have a “donut hole” feature. MCHCP made sure that the plan it offers to Medicare primary members does not have a gap in coverage.
After Open Enrollment, will I receive confirmation that I’m enrolled in the Medicare Prescription Drug Plan?
The Medicare Prescription Drug Plan is included with both the PPO 600 and PPO 300 medical plans, or you can choose to enroll in the Medicare Prescription Drug Only Plan with no medical coverage. You will receive a confirmation from MCHCP by email or mail that confirms your plan selection. In December, you will receive more detailed prescription drug plan information from Express Scripts Medicare, which will include a new Express Scripts member ID card, formulary (approved drug list), pharmacy directory and appeal information.
What is the Extra Help program?
People with limited incomes may qualify for Extra Help to pay for their Medicare prescription drug costs. For more information about Extra Help, contact your local Social Security office or call Social Security at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 800-325-0778.
Am I still able to use Veterans Affairs (VA) pharmacies?
VA pharmacies are not included in Medicare Part D pharmacy networks. If you are eligible for VA benefits, you can still use VA pharmacies under those benefits. However, the cost of medications purchased at a VA pharmacy will not count toward your Express Scripts Medicare yearly out-of-pocket maximum. Review your Express Scripts Medicare benefit against your VA benefit to determine the best option for you. You may use your VA benefit at your VA pharmacy or transfer your prescription(s) to an Express Scripts Medicare network pharmacy.