PACE

PROVIDER BULLETIN

January 26, 2007

PACE Plus Medicare

Listed below are the Medicare Part D plans that have partnered with PACE for 2007. Providers will notice three additional plans (identified by an asterisk *). Providers should also take note that some plans have changed their copay as well as their formulary.

As before, the PACE Program is recommending that cardholders using the prescription drug benefit enroll in one of the following plans if they are not currently enrolled in a Medicare Advantage Plan or an employer retiree plan.

PACENET cardholders not enrolled in a Part D plan listed below will be responsible for a monthly PACENET premium of $28.45 plus the copay(s).

Plan	BIN	Premium	Deductible	Generic Copay	Copays: Brand, NP, Specialty
AmeriHealth Advantage (IBC)	012353	$28.45	$265	25% 30-day retail & mail order (Walgreens)	Brand--25% NP Brand--25% Specialty--25%
First Health Premier	610029	$28.45	$265	$5 (& few brands) 90-day retail, 3 copays No Mail Order CAREMARK Spcty	Brand--$25 NP Brand--$58 Specialty--25% 90-day retail, 3 copays No Mail Order
* Elder Health BravoRx II	610014	$23.60	$265	25% 90-day mail 25%	Brand--25% 90-day mail 25% Specialty--25% 90-day mail 25%
* Geisinger Gold Rx Submission Time— 60 days from DOS	012353	22.80	0	$5 90-day mail, $12.50 Medco	Brand -$36 90-day mail, $90 NP Brand--$78 90-day mail, $195

(over)

Plan	BIN	Premium	Deductible	Generic Copay	Copays: Brand, NP, Specialty
Highmark BlueRx Plus 90 days submission	610014	$23.20	$0	$6 90 day retail, $18 90 day mail, $15 MEDCO Mail Order	Brand-$29; 90 day retail-- $87 90 day mail-- $72.50 NP --$50 90 day retail-- $150 90 day mail-- $125 Spec –25% 90 day retail—25% 90 day mail—25%
Humana --Standard	610649	$14.80	$265	25% 30 or 90-day retail & mail- 3 copays	Brand—N/A NP Brand—N/A Specialty—N/A
Humana--Enhanced	610649	$22.90	$0	$5 90 day mail—3 copays	Brand--$30 NP Brand--$60 Specialty-- 25% 90 day mail—3 copays-- applicable to all
MemberHealth Community Care Rx Basic	012304	$28.70	$265	$0 90-day retail, $0 copay	Brands—25% 90-day retail, 25% copay NP Brands—50% 90-day retail, 50% copay
Ovations: AARP Medicare RX Saver (Managed Formulary)	610097	$20.80	$265	$5 90-day mail, $5 copay Mail Order-- Rx Solutions; WHI (Walgreens)	Brand--$20 90-day mail, $45 copay NP Brand--$45.20 90-day mail, $120 copay Specialty-- 25% 90-day mail, 25% copay
* UPMC for Life Submission time- 14 days from DOS	003858 PCN: Medicare Part D only: PMDA	$23.50	$0	$5 90 day retail & mail –3 copays NOTE: Not all retail can do 90 day. Express Scripts for Mail Order	Brands:$32 90 day retail & mail –3 copays NP Brands $64 90 day retail & mail –3 copays Low cost Injectables—25% 90 day retail & mail –3 copays Specialty—33% copay 90-day mail 33% copay.

CATASTROPHIC COVERAGE: The listed plans have a $2 generic; $5 brand or 5% copay--whichever is greater.

Note:

· Part D plans may require specific provider contracts to dispense 90 days at retail.

· PACE cardholders may belong to plans other than the plans listed above. In all cases providers should ask PACE cardholders for their PACE card and if they are enrolled in a Part D plan.

· When a Part D’s plan’s copay is greater than the PACE/PACENET copay, be sure to bill the Program to allow the cardholder to pay the lower copay.

· Claims with copays lower than PACE/PACENET need not be billed to PACE/PACENET.

Questions may be directed to Provider Services at 1-800-835-4080.