PACE
PROVIDER BULLETIN
Medicare Part D Plans
Listed below are the Medicare Part D plans that have been
selected as partner plans with PACE for 2009, pending final execution of their
Agreements with the Department of Aging.
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 |
$28.60 |
$295 |
25% |
25% |
25% |
25% |
|
MemberHealth Community CCRx Basic |
012304 |
MPD |
NO Mail Order— 90 day
supplies available at retail |
$25.40 |
$295 |
$0 |
30% |
45% |
NA |
|
RxAmerica Advantage Star Plan |
012189 |
5000 |
RX Escalante
Solutions |
$27.80 |
$295 |
$5.50 |
25% |
25% . |
45% |
|
First Health Premier |
610029 |
CRX |
NO Mail Order— 90 day
supplies available at retail |
28.70 |
$0 |
$7 |
$27 |
$52 |
33% |
|
UHC AARP Medicare Rx Saver |
610097 |
9999 |
Walgreens;
WHI RX
Solutions |
$22.40 |
$295 |
$5 |
$22.00 |
$60.05 |
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 $29.23 (2009).
·
Cardholders
enrolled in a plan with a premium higher than $29.23 must pay the difference to the plan.
·
Catastrophic Coverage: Copay = the
greater of $2.40 generic; $6.00 brand or 5%.
PACENET Cardholders:
- Cardholders not
enrolled in any Part D plan will have the 2009 Benchmark premium of $29.23
assessed (deducted) at the point of sale. Note: This is the same procedure
currently in place.
PACENET cardholders enrolled in 1 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 $29.23 plus the
copay being returned in the response, the partner’s plan premium ($28.60,
$25.40 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 $2.40 generic; $6.00 brand or 5%.
The most
current PACE/PACENET information can be found on the PACE Cares website at PACEcares.fhsc.com.
Cardholder Inquiries should be
directed to 1-800-225-7223.
Provider Questions may be directed
to Provider Services at 1-800-835-4080.