Pharmacy and Drug Benefits

Prescription medication is a blessing

You are likely living a healthy and independent life thanks to earlier disease detection and better medications designed to manage it.

Americans aged 65 to 84 take an average of up to 18 prescriptions a year, according to the American Society of Consultant Pharmacists. Medication is necessary for healthy aging, but managing several medications can be expensive and confusing.

Many of our Medicare Advantage plans automatically include Part D drug coverage that makes prescription drugs affordable and convenient. Depending on the plan, our enhanced drug coverage generally includes benefits such as $0 copay on preferred generics and no Part D deductible. All of our plans include Tier 1 drug coverage in the gap and access to 66,000 network pharmacies nationwide.

Our Formulary contains ALL of the top 100 prescribed drugs. We cover a large selection of generic and brand medications to choose from. Plus, our plans cover Tier 1 drugs in the coverage gap, which means extra savings for you! And to keep things hassle-free, we don’t require step therapy, a type of prior authorization that requires you to try a less expensive drug before stepping up to the originally prescribed drug.

We also offer a generous quarterly allowance to help you pay for over-the-counter medications, as well as health and wellness products such as common cold medicine, vitamins and more.

Our partnership with CVS Caremark allows you to enjoy the benefit of a mail-order pharmacy service. You can save time and money by reducing trips to a pharmacy for medications you take regularly, also known as maintenance drugs. CVS Caremark offers automatic refills, which means they track your refill schedules and ensure you receive your medication on time.

Concerns over whether a prescribed medication is covered under your plan are put to rest with our real-time formulary and benefit information. Eligible members will also have access to our Medication Therapy Management (MTM) program, which helps you to avoid medication-related problems such as side effects and interactions.

Call to speak with one of our trusted advisors at 1-800-964-4525 (TTY: 711) or to enroll and begin enjoying benefits like this. Receive the benefits of prescription medication without being weighed down by the cost and confusion that often come with it.

Quality Assurance

Mount Carmel Health Plan has systems in place to ensure members receive appropriate care that is also safe. Our processes include a review of prescription drug claims in an effort to:

• Reduce medication errors that may cause adverse reactions.
• Prevent use of unsafe dosage amounts.
• Avoid duplicate or unnecessary drugs.

These procedures are beneficial for all members, and in particular, those who have more than one prescribing doctor, use more than one drug, or have more than one pharmacy.