PACE

PROVIDER BULLETIN

November 30, 2007

PACE Plus Medicare

Listed below are the Medicare Part D plans that have partnered with PACE for 2008.

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. As in previous years, Part D plans are chosen for cardholders based on the individual’s pharmaceutical history. Additionally, the Program makes every effort to place cardholders into plans in which their pharmacy participates.

Partner Part D Plans	BIN	PCN	Mail Order	Prem	Deduct	Tier 1	Tier 2	Tier 3	Tier 4
						Generic	Prefer’d Brand	Non-Prefer’d Brand	Specialty
AmeriHealth Advantage (IBC) Rx Option 1	012353	03660000	Walgreens Mail Service: 1-month or 34 day supply	$26.50	$275	25%	25%	N/A	N/A
MemberHealth Community CCRx Basic	012304	MPD	NO Mail Order— 90 day supplies are available at retail	$25.50	$275	$0	30%	60%	N/A
RxAmerica Advantage Star Plan	012189	5000	RX America; Escalante Solutions	$20.40	$275	$5.50	25%	25% Spec .	35% NPBr
SilverScript Ins. Company SilverScript	004336	ADV	Caremark	$21.60	$275	$7	$23.75	$94	25%
UHC AARP Medicare Rx Saver	610097	9999	Walgreens; WHI	$25.20	$275	$5	$20	$50.30	25%

CARDHOLDER INFORMATION

PACE Cardholders:

· The PACE Program will pay the Part D premiums for PACE cardholders enrolled in one of the program’s 5 partner Part D plans.

· IF PACE has secured an agreement with a non-partner plan to pay the Part D plan premium, PACE will pay up to the regional benchmark of $26.59 (2008). 

· Cardholders enrolled in a plan with a premium higher than $26.59 must pay the difference to the plan.

· Catastrophic Coverage: Copay = the greater of $2.25 generic; $5.60 brand or 5%.

PACENET Cardholders:

• Cardholders not enrolled in any Part D plan will have the 2008 Benchmark premium of $26.59 assessed (deducted) at the point of sale. Note: This is the same procedure currently in place.

• PACENET cardholders enrolled in one of the 5 partner plans will have the plan’s premium collected (deducted) by including it in the amount due from the cardholder plus the lower of the plan’s or PACENET’s copay.

• NOTE: This is the same process used for PACENET cardholders not enrolled in a Part D plan. The only difference is that instead of the benchmark of $26.59 plus the copay being returned in the response, the partner’s plan premium ($26.50; $20.40 etc.) plus the applicable copay will be returned in the response.

• PACENET cardholders in non-partner plans will be billed by the plan. The cardholder will pay the premium directly to the plan and will pay only copays at the pharmacy.

· Catastrophic Coverage: Copay = the greater of $2.25 generic; $5.60 brand or 5%.

Cardholder Inquiries should be directed to 1-800-225-7223.

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