PACE

PROVIDER BULLETIN

July 28, 2006

PACE Plus Medicare

 

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.

 

Plan

Premium

Deductible

Generic Copay

Copays: Brand, NP, Spec.

 

 

 

 

 

AmeriHealth Advantage (IBC)

Option 1

 

$24.18

 

$250

 

25%

Brand--25%

NP Brand--25%

Specialty--25%

 

 

 

 

 

First Health Premier

 

$27.21

 

$250

 

25%

90-day retail, 3 copays

Brand--25%

NP Brand--25%

Specialty--25%

90-day retail, 3 copays

 

 

 

 

 

Highmark BlueRx Basic

$26.55

$0

$10

 

 Brand-$30; NP & Spec-NA 

 

 

 

 

90 day retail, $25

90 day retail, $75

 

 

 

90 day mail,  $25

90 day mail,  $75

 

 

 

 

 

Humana --Standard

 

$10.14

 

$250

25%

30-day or

90-day retail & mail

 

Brand--25%

NP Brand--25%

Specialty--25%

 

 

 

 

 

Humana--Enhanced

 

$16.94

 

$250

$0/$7 after deductible is met

Brand--$30

NP Brand--$60

Specialty-- 25%

 

 

 

90-day retail, $0 until $250 is met

90-day retail, $21 after deductible is met

Brand-90-day retail,

$90 copay;

NP Brand 90-day retail,

$180 copay

Spec. 90-day retail,

25% copay

 

 

 

 

 

 

 

 

90-day mail, $0 until $250 is met

90-day mail, $17.50 after deductible is met

Brand 90-day mail,

$75 copay;

NP Brand 90-day mail

$150 copay

Spec. 90-day mail

 25% copay

 

 

 

 

 

MemberHealth Community Care Rx Basic

 

$32.10

 

$250

 

$0

90-day retail, $0 copay

Brands—25%

90-day retail, 25% copay

NP Brands—45%

90-day retail, 45% copay

 

 

 

 

 

Ovations:

 

 

 

 

United Medicare

Med Advance

 

$29.20

 

$0

 

$10

Brand--$23

NP Brand--$53

Specialty-- 25%

 

 

 

90-day retail, $30 copay

90-day mail,  $30 copay

Brands:

90-day retail, $69 copay;

90-day mail,  $69 copay

 

 

 

 

NP Brands

90-day retail  $159 copay;

90-day mail,  $159 copay

 

 

 

 

Specialty

90-day retail, 25% copay;

90-day mail,  25% copay

 

 

 

 

 

Ovations: AARP Medicare RX

 

$29.03

 

$0

 

$5

Brand--$28

NP Brand--$55

Specialty-- 25%

 

 

 

90-day retail, $15 copay;

90-day mail,  $15 copay

Brands:

90-day retail, $84 copay;

90-day mail,  $84 copay

 

 

 

 

NP Brands

90-day retail $165 copay;

90-day mail, $165 copay

 

 

 

 

Specialty

90-day retail 25% copay;

90-day mail, 25% copay

 

 

 

 

 

PacifiCare Saver

 

$25.20

 

$0

 

$7.50

Brand--$22

NP Brand--$50.85

Specialty—33%

 

 

 

 

90-day mail, $15 copay

Brand—90-day mail

$44 copay

NP Brand—90-day mail

$101.70 copay

Specialty—90-day mail

33% copay

 

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

 

Please 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. 

 

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