The prescription drugs your D-SNP covers are shown in a formulary, also called a Drug List. Your formulary shows which Medicare Part D prescription drugs are covered under your Medicare Part D benefits. It also stays updated with any drug restrictions.
Our Medication Therapy Management (MTM) Program is a no cost program that helps our members get the most out of their medication. If you choose to join the MTM program, a pharmacist or other health professional will review all your medications, then talk with you about:
You’ll also get a written summary with next steps if needed.
At Highmark Wholecare we feel that medication coverage goes beyond prescriptions. This is why Over-the-Counter (OTC) benefits have been added to your D-SNP. You’ll get an OTC allowance every three months, offering you four shopping periods a year to buy plan approved items. You can place your orders:
Note, the amount you’ll get every three months depends on your D-SNP plan.
Your D-SNP prescription drug benefits includes both Medicare Part D and Medicaid prescription drug coverage. When you doctor writes a prescription, your drug coverage offers:
Remember to show your membership card each time you visit your pharmacy.
Your D-SNP prescription drug benefits follow rules and coverage limits, called step therapy, for medically administered Medicare Part B drugs. In some instances, like injectables or biologics, step therapy has you try a preferred drug first before non-preferred drugs are covered.