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:

 

 

 

 

 

·        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.