PACE

PROVIDER BULLETIN

November 14, 2008

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 America;

Escalante Solutions

 

$27.80

 

 

$295

 

 

$5.50

 

 

25%

 

 

25%

 

.

45%

 

 

Coventry

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.