SilverScript Employer PDP sponsored by Montgomery County Public Schools (SilverScript) Annual Notice of Changes for 2019

Transcription

1 P.O. Box 30006, Pittsburgh, PA SiverScript Empoyer PDP sponsored by Montgomery County Pubic Schoos (SiverScript) Annua Notice of Changes for 2019 You are currenty enroed as a member of SiverScript. Next year, there may be some changes to the pan s costs and benefits. This booket tes about the changes. You have from October 8 unti November 2 to make changes to your SiverScript coverage for next year. What to do now 1. ASK: Which changes appy to you Check the changes to our benefits and costs to see if they affect you. It s important to review your coverage now to make sure it wi meet your needs next year. Do the changes affect the services you use? Look in Section 1 for information about benefit and cost changes for our pan. Check the changes in this booket for your prescription drug coverage to see if they affect you. Wi your drugs be covered? Are your drugs in a different tier, with different cost sharing? Do any of your drugs have new restrictions, such as needing approva from us before you fi your prescription? Can you keep using the same pharmacies? Are there changes to the cost of using these pharmacies? Review the 2019 Drug List and ook in Section 1.3 for information about changes to our drug coverage. Your drug costs may have risen since ast year. Tak to your doctor about ower cost aternatives that may be avaiabe for you; this may save you in annua out-of-pocket costs throughout the year. Keep in mind that your pan benefits wi determine exacty how much your own drug costs may change. Think about your overa heath care costs. How much wi you spend out-of-pocket for the services and prescription drugs you use reguary? How much wi you spend on your premium and deductibes? How do your tota pan costs compare to other Medicare coverage options? Think about whether you are happy with our pan. Y0080_52002_ANOC_CLT_2019_M_9490_2664_801 OMB Approva (Pending OMB Approva)

2 2. COMPARE: Learn about other pan choices Check coverage and costs of pans in your area. Use the personaized search feature on the Medicare Pan Finder at Cick Find heath & drug pans. Review the ist in the back of your Medicare & You handbook. Look in Section 2 to earn more about your choices. Once you narrow your choice to a preferred pan, confirm your costs and coverage. 3. CHOOSE: Decide whether you want to change your pan If you want to keep SiverScript, you don t need to do anything. You wi stay in SiverScript. To change to a different pan that may better meet your needs, you can switch pans between October 8 and November 2. Additiona Resources This document is avaiabe for free in Spanish. Pease contact SiverScript Customer Care at for additiona information. (TTY users shoud ca 711.) Hours are 24 hours a day, 7 days a week. ATENCIÓN: Si usted haba españo u otros idiomas, tenemos servicios de asistencia ingüística disponibes para usted sin costo aguno. Lame a (TTY: 711). This information is avaiabe in a different format, incuding Braie, arge print, and audio formats. Pease ca SiverScript Customer Care if you need pan information in another format. Discaimers The formuary and/or pharmacy network may change at any time. You wi receive notice when necessary. This information is not a compete description of benefits. Ca (TTY: 711) for more information. About SiverScript SiverScript Empoyer PDP is a Prescription Drug Pan. This pan is offered by SiverScript Insurance Company, which has a Medicare contract. Enroment depends on contract renewa. When this booket says we, us, or our, it means SiverScript Insurance Company. When it says pan or our pan, it means SiverScript.

3 SiverScript Annua Notice of Changes for Summary of Important Costs for 2019 The tabe beow compares the 2018 costs and 2019 costs for SiverScript in severa important areas. Pease note this is ony a summary of changes. It is important to read the rest of this Annua Notice of Changes and review the encosed Evidence of Coverage to see if other benefit or cost changes affect you. Cost 2018 (this year) 2019 (next year) Monthy pan premium* *Your premium may be higher or ower. See Section 1.1 for detais. (You must continue to pay your Medicare Part B premium, if appicabe.) Part D prescription drug coverage (See Section 1.3 for detais.) Pease contact Montgomery County Pubic Schoos for more information about the premium for this pan. You have no deductibe. Your share of the cost during the Initia Coverage Stage: Network Retai Pharmacy (34-day suppy avaiabe at any network pharmacy) $10.00 $25.00 $35.00 Preferred Network Retai Pharmacy (90-day) Non-Preferred Network Retai Pharmacy (90-day) $30.00 $75.00 $ Pease contact Montgomery County Pubic Schoos for more information about the premium for this pan. You have no deductibe. Your share of the cost during the Initia Coverage Stage: Network Retai Pharmacy (34-day suppy avaiabe at any network pharmacy) $10.00 $25.00 $35.00 Preferred Network Retai Pharmacy (90-day) Non-Preferred Network Retai Pharmacy (90-day) $30.00 $75.00 $105.00

4 SiverScript Annua Notice of Changes for Cost 2018 (this year) Mai Order (90-day) 2019 (next year) Mai Order (90-day)

5 SiverScript Annua Notice of Changes for Annua Notice of Changes for 2019 Tabe of Contents Summary of Important Costs for SECTION 1 Changes to Benefits and Costs for Next Year...4 Section 1.1 Changes to the Monthy Premium... 4 Section 1.2 Changes to the Pharmacy Network... 4 Section 1.3 Changes to Part D Prescription Drug Coverage... 4 SECTION 2 Deciding Which Pan to Choose...8 Section 2.1 If You Want to Stay in SiverScript... 8 Section 2.2 If You Want to Change Pans... 8 SECTION 3 Deadine for Changing Pans...9 SECTION 4 Programs That Offer Free Counseing about Medicare...9 SECTION 5 Programs That Hep Pay for Prescription Drugs...10 SECTION 6 Questions?...10 Section 6.1 Getting Hep from SiverScript Section 6.2 Getting Hep from Medicare... 11

6 SiverScript Annua Notice of Changes for SECTION 1 Changes to Benefits and Costs for Next Year Section 1.1 Changes to the Monthy Premium Cost 2018 (this year) 2019 (next year) Monthy pan premium (You must continue to pay your Medicare Part B premium, if appicabe.) Pease contact Montgomery County Pubic Schoos for more information about the premium for this pan. Pease contact Montgomery County Pubic Schoos for more information about the premium for this pan. Your monthy pan premium wi be more if you are required to pay a ifetime Part D ate enroment penaty for going without other drug coverage that is at east as good as Medicare drug coverage (aso referred to as creditabe coverage ) for 63 days or more. Chapter 1 in the Evidence of Coverage expains the Part D ate enroment penaty. Montgomery County Pubic Schoos has eected to pay for your Part D ate enroment penaty on your pan. However, if you join another pan, your Part D ate enroment penaty may not be covered and you may be responsibe for paying your Part D ate enroment penaty. If you have a higher income, you may have to pay an additiona amount each month directy to the government for your Medicare prescription drug coverage. This additiona amount is caed Part D Income Reated Monthy Adjustment Amount (Part D IRMAA). Chapter 1 in the Evidence of Coverage expains Part D IRMAA. Your monthy premium may be ess if you are receiving Extra Hep with your prescription drug costs. Section 1.2 Changes to the Pharmacy Network Amounts you pay for your prescription drugs may depend on which pharmacy you use. Medicare prescription drug pans have a network of pharmacies. In most cases, your prescriptions are covered ony if they are fied at one of our network pharmacies. Pease reference Chapter 3 in the Evidence of Coverage which expains how to ocate and fi prescriptions at network pharmacies. There may be changes to our network of pharmacies for next year. We incuded a copy of our Pharmacy Directory in the enveope with this booket. You may aso ca SiverScript Customer Care for updated pharmacy information. Pease review the 2019 Pharmacy Directory to see which pharmacies are in our network. Section 1.3 Changes to Part D Prescription Drug Coverage Changes to Our Drug List Our ist of covered drugs is caed a Formuary or Drug List. The Drug List we incuded in this maiing incudes many but not a of the drugs that we wi cover under the Medicare Part D portion of your pan next year. It does not incude drugs that you can get due to the additiona coverage provided by Montgomery County Pubic Schoos. If you don t see your drug on this ist, it might sti be covered. You can get the compete Drug List with a the drugs covered by the Medicare Part D portion of the pan by caing SiverScript Customer Care.

7 SiverScript Annua Notice of Changes for We may make changes to our Drug List, incuding changes to the drugs we cover and changes to the restrictions that appy to our coverage for certain drugs. Review the Drug List to make sure your drugs wi be covered next year and to see if there wi be any restrictions. Restrictions incude: Prior Authorization (PA): For certain prescription drugs, you or your provider need to get approva from the pan before SiverScript wi agree to cover the drug for you. This is caed prior authorization. If you do not get this approva, your prescription drug might not be covered by SiverScript. Quantity Limits (QL): For certain prescription drugs, SiverScript imits the amount of the prescription drug that you can get each time you fi your prescription. For exampe, if it is normay considered safe to take ony one pi per day for a certain drug, we may imit coverage for your prescription to no more than one pi per day. This is caed quantity imits. If there is a restriction for your drug, it usuay means that you or your provider wi have to take extra steps in order for us to cover the drug. If there is a restriction on the drug you want to take, you shoud contact SiverScript Customer Care to earn what you or your provider woud need to do to get coverage for the drug. Pease note: Montgomery County Pubic Schoos provides additiona coverage that may cover prescription drugs not incuded in your Medicare Part D benefit. There may be instances where your share of the cost may be more or ess due to this additiona coverage. If you are unsure about your share of the cost or which drugs may or may not be covered, pease ca SiverScript Customer Care. If you are affected by a change in the drugs covered by the Medicare Part D portion of your drug coverage, you can: Work with your doctor (or other prescriber) and ask the pan to make an exception to cover the drug. We encourage current members to ask for an exception before next year. To earn what you must do to ask for an exception, see Chapter 7 of your Evidence of Coverage (What to do if you have a probem or compaint (coverage decisions, appeas, compaints)) or ca SiverScript Customer Care. Work with your doctor (or other prescriber) to find a different drug that we cover. You can ca SiverScript Customer Care to ask for a ist of covered drugs that treat the same medica condition. In some situations, we are required to cover a temporary suppy of a non-formuary drug in the first 90 days of the pan year or the first 90 days of membership to avoid a gap in therapy. For 2019, members in ong-term care (LTC) faciities wi now receive a temporary suppy of 31 days of medication rather than the amount provided in 2018 (34 days of medication). (To earn more about when you can get a temporary suppy, see Chapter 3, Section 5.2 of the Evidence of Coverage.) Whie you are getting a temporary suppy of a drug, you shoud tak with your doctor to decide what to do when your temporary suppy runs out. You can either switch to a different drug covered by the pan or ask the pan to make an exception for you and cover your current drug. If you previousy received a prior authorization (PA) for a drug that is being removed from the formuary in 2019, that drug wi no onger be covered even if your PA extends into 2019 or beyond. Pease review your copy of the 2019 formuary to determine which drugs are covered in 2019.

8 SiverScript Annua Notice of Changes for If you currenty have a formuary exception for a drug you are taking, pease refer to the etter you received that granted the exception to see whether your exception continues beyond the pan year. If it states your formuary exception wi expire at the end of the pan year, you wi need to submit a new exception request for the drug if its formuary status has not changed. You can ca SiverScript Customer Care with questions about your current formuary exception. Most of the changes in the Drug List are new for the beginning of each year. However, during the year, we might make other changes that are aowed by Medicare rues. Starting in 2019, we may immediatey remove a brand name drug on our Drug List if, at the same time, we repace it with a new generic drug on the same or ower cost-sharing tier and with the same or fewer restrictions. Aso, when adding the new generic drug, we may decide to keep the brand name drug on our Drug List, but immediatey move it to a different cost-sharing tier or add new restrictions. This means if you are taking the brand name drug that is being repaced by the new generic (or the tier or restriction on the brand name drug changes), you wi no onger aways get notice of the change 60 days before we make it or get a 60-day refi of your brand name drug at a network pharmacy. If you are taking the brand name drug, you wi sti get information on the specific change we made, but it may arrive after the change is made. Aso, starting in 2019, before we make other changes during the year to our Drug List that require us to provide you with advance notice if you are taking a drug, we wi provide you with notice 30, rather than 60, days before we make the change. Or we wi give you a 34-day, rather than a 60-day, refi of your brand name drug at a network pharmacy. When we make these changes to the Drug List during the year, you can sti work with your doctor (or other prescriber) and ask us to make an exception to cover the drug. We wi aso continue to update our onine Drug List as schedued and provide other required information to refect drug changes. (To earn more about the changes we may make to the Drug List, see Chapter 3, Section 6 of the Evidence of Coverage.) Changes to Prescription Drug Costs Note: If you are in a program that heps pay for your drugs ( Extra Hep ), the information about costs for Part D prescription drugs may not appy to you. We have incuded a separate insert, caed the Evidence of Coverage Rider for Peope Who Get Extra Hep Paying for Prescription Drugs (aso caed the Low Income Subsidy Rider or the LIS Rider ), which tes you about your drug costs. If you receive Extra Hep and didn t receive this insert with this packet, pease ca SiverScript Customer Care and ask for the LIS Rider. Phone numbers for SiverScript Customer Care are in Section 6.1 of this booket. There are four drug payment stages. How much you pay for a Part D drug depends on which drug payment stage you are in. (You can ook in Chapter 4, Section 2 of your Evidence of Coverage for more information about the stages.) The foowing information shows the changes for next year to the first two drug payment stages the Deductibe Stage and the Initia Coverage Stage. (Most members do not reach the other two stages the Coverage Gap Stage or the Catastrophic Coverage Stage. The Coverage Gap Stage and the Catastrophic Coverage Stage are for peope with high drug costs. To get information about your costs in these stages, ook at Chapter 4, Sections 6 and 7 of the encosed Evidence of Coverage.) Changes to the Deductibe Stage Stage 2018 (this year) Stage 1: Deductibe Stage Because you have no deductibe, this payment stage does not appy to you (next year) Because you have no deductibe, this payment stage does not appy to you.

9 SiverScript Annua Notice of Changes for Changes to Your Cost Sharing in the Initia Coverage Stage To earn how copayments and coinsurance work, ook at Chapter 4, Section 1.2, Types of out-of-pocket costs you may pay for covered drugs, in your Evidence of Coverage. Stage 2018 (this year) Stage 2: Initia Coverage Stage Your share of the cost during the Initia Coverage Stage: 2019 (next year) Your share of the cost during the Initia Coverage Stage: Since you do not have an annua deductibe, you start in the Initia Coverage Stage when you fi your first prescription of the year. During this stage, the pan pays its share of the cost of your drugs and you pay your share of the cost. You pay the costs in this tabe when you fi your prescription at a network retai pharmacy. For information about the costs for a ong-term suppy or for mai-order prescriptions, ook in Chapter 4, Section 5 of your Evidence of Coverage. We changed the tier for some of the prescription drugs on our Drug List. To see if your drugs wi be in a different tier, ook them up on the Drug List. Network Retai Pharmacy (34-day suppy avaiabe at any network pharmacy) $10.00 $25.00 $35.00 Preferred Network Retai Pharmacy (90-day) Non-Preferred Network Retai Pharmacy (90-day) $30.00 $75.00 $ Mai Order (90-day) Network Retai Pharmacy (34-day suppy avaiabe at any network pharmacy) $10.00 $25.00 $35.00 Preferred Network Retai Pharmacy (90-day) Non-Preferred Network Retai Pharmacy (90-day) $30.00 $75.00 $ Mai Order (90-day) Once your tota drug costs have reached $3,750, you wi move to the next stage (the Coverage Gap Stage). Once your tota drug costs have reached $3,820, you wi move to the next stage (the Coverage Gap Stage).

10 SiverScript Annua Notice of Changes for Changes to the Coverage Gap and Catastrophic Coverage Stages The other two drug coverage stages the Coverage Gap Stage and the Catastrophic Coverage Stage are for peope with high drug costs. Most members do not reach the Coverage Gap Stage or the Catastrophic Coverage Stage. Due to the additiona coverage provided by Montgomery County Pubic Schoos, you have the same copayments or coinsurance during the coverage gap that you had during the Initia Coverage Stage. Therefore, you may see no change in your copayment and/or coinsurance unti you quaify for catastrophic coverage. You quaify for the Catastrophic Coverage Stage when your Medicare true out-of-pocket (aso known as TrOOP) costs have reached the $5,100 imit for the pan year. Once you are in the Catastrophic Coverage Stage, you wi stay in this payment stage unti the end of the pan year. For information about your costs in these stages, ook at Chapter 4, Sections 6 and 7 in your Evidence of Coverage. SECTION 2 Deciding Which Pan to Choose Section 2.1 If You Want to Stay in SiverScript To stay in our pan, you don t need to do anything. If you do not sign up for a different pan by November 2, you wi automaticay stay enroed as a member of our pan for Section 2.2 If You Want to Change Pans We hope to keep you as a member next year, but if you want to change for 2019, foow these steps: Step 1: Learn about and compare your choices You can stay in your current prescription drug pan. You can join a different Medicare prescription drug pan. You can change to a Medicare heath pan. Some Medicare heath pans aso incude Part D prescription drug coverage. You can keep your current Medicare heath coverage and drop your Medicare prescription drug coverage. To earn more about Origina Medicare and the different types of Medicare pans, read Medicare & You 2019, ca your State Heath Insurance Assistance Program (SHIP) (see Section 4 for contact information), or ca Medicare (see Section 6.2). You can aso find information about pans in your area other than SiverScript by using the Medicare Pan Finder on the Medicare website. Go to and cick Find heath & drug pans. Here you can find information about costs, coverage, and quaity ratings for Medicare pans. Step 2: Change your coverage To change to a different Medicare prescription drug pan, enro in the new pan. You wi automaticay be disenroed from SiverScript. To change to a Medicare heath pan, enro in the new pan. Depending on which type of pan you choose, you wi automaticay be disenroed from SiverScript. You wi automaticay be disenroed from SiverScript if you enro in any Medicare heath pan that incudes Part D prescription drug coverage. You wi

11 SiverScript Annua Notice of Changes for aso automaticay be disenroed if you join a Medicare HMO or Medicare PPO, even if that pan does not incude prescription drug coverage. If you choose a Private Fee-For-Service pan without Part D drug coverage, a Medicare Medica Savings Account pan, or a Medicare Cost Pan, you can enro in that new pan and keep SiverScript for your drug coverage. Enroing in one of these pan types wi not automaticay disenro you from SiverScript. If you are enroing in this pan type and want to eave our pan, you must ask to be disenroed from SiverScript. To ask to be disenroed, you must send us a written request or contact Medicare at MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca To change to Origina Medicare without a prescription drug pan, you must either: Send us a written request to disenro. Contact SiverScript Customer Care if you need more information on how to do this (phone numbers are in Section 6.1 of this booket). OR Contact Medicare at MEDICARE ( ), 24 hours a day, 7 days a week, and ask to be disenroed. TTY users shoud ca SECTION 3 Deadine for Changing Pans You can make a change during the Annua Enroment Period for Montgomery County Pubic Schoos from October 8 November 2. If you disenro from Medicare prescription drug coverage and go without creditabe prescription drug coverage, you may need to pay a Part D ate enroment penaty if you join a Medicare drug pan ater. See Chapter 1 in the Evidence of Coverage for more information about the Part D ate enroment penaty. Are there other times of the year to make a change? In certain situations, changes are aso aowed at other times of the year. For exampe, peope with Medicaid, those who get Extra Hep paying for their drugs, those who have or are eaving empoyer coverage, and those who move out of the service area may be aowed to make a change at other times of the year. For more information, see Chapter 8, Section 2.2 of the Evidence of Coverage. Note: If you re in a drug management program, you may not be abe to change pans. SECTION 4 Programs That Offer Free Counseing about Medicare A State Heath Insurance Assistance Program (SHIP) is a government program with trained counseors in every state. A SHIP is independent (not connected with any insurance company or heath pan). It is a state program that gets money from the Federa government to give free oca heath insurance counseing to peope with Medicare. SHIP counseors can hep you with your Medicare questions or probems. They can hep you understand your Medicare pan choices and answer questions about switching pans. To earn more about the program, check with your state s SHIP (the name and phone numbers for this organization are in the Appendix of your Evidence of Coverage).

12 SiverScript Annua Notice of Changes for SECTION 5 Programs That Hep Pay for Prescription Drugs You may quaify for hep paying for prescription drugs. Listed beow are three different kinds of hep: Extra Hep from Medicare. Peope with imited incomes may quaify for Extra Hep to pay for their prescription drug costs. If you quaify, Medicare coud pay up to 75% or more of your drug costs, incuding monthy prescription drug premiums, annua deductibes, and coinsurance. Additionay, those who quaify wi not have a coverage gap or Part D ate enroment penaty. Many peope are eigibe and don t even know it. To see if you quaify, ca: MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca ; The Socia Security Office at between 7 a.m. and 7 p.m., Monday through Friday. TTY users shoud ca (appications); or Your State Medicaid Office (appications). Hep from your state s pharmaceutica assistance program. A State Pharmaceutica Assistance Program (SPAP) heps peope pay for prescription drugs based on their financia need, age, or medica condition. To earn more about the program, check with your state s SPAP (the name and phone numbers for this organization are in the Appendix of your Evidence of Coverage). Prescription cost-sharing assistance for persons with HIV/AIDS. The AIDS Drug Assistance Program (ADAP) heps ensure that ADAP-eigibe individuas iving with HIV/AIDS have access to ife-saving HIV medications. Individuas must meet certain criteria, incuding proof of state residence and HIV status, ow income as defined by the state, and uninsured/underinsured status. Medicare Part D prescription drugs that are aso covered by ADAP quaify for prescription cost-sharing assistance through your state s ADAP. For information on eigibiity criteria, covered drugs, or how to enro in the program, pease ca your state s ADAP (the name and phone numbers for this organization are in the Appendix of your Evidence of Coverage). SECTION 6 Questions? Section 6.1 Getting Hep from SiverScript Questions? We re here to hep. Pease ca SiverScript Customer Care at TTY users shoud ca 711. We are avaiabe for phone cas 24 hours a day, 7 days a week. Cas to these numbers are free. Read your 2019 Evidence of Coverage (it has detais about next year's benefits and costs) This Annua Notice of Changes gives you a summary of changes in your benefits and costs for For detais, ook in the 2019 Evidence of Coverage for SiverScript. The Evidence of Coverage is the ega, detaied description of your pan benefits. It expains your rights and the rues you need to foow to get covered services and prescription drugs. A copy of the Evidence of Coverage is incuded in this enveope. Visit our Website You can aso visit our website at Caremark.com. As a reminder, our website has the most up-to-date information about our pharmacy network.

13 SiverScript Annua Notice of Changes for Section 6.2 Getting Hep from Medicare To get information directy from Medicare: Ca MEDICARE ( ) You can ca MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca Visit the Medicare Website You can visit the Medicare website ( It has information about cost, coverage, and quaity ratings to hep you compare Medicare prescription drug pans. You can find information about pans avaiabe in your area by using the Medicare Pan Finder on the Medicare website. To view the information about pans, go to and cick on Find heath & drug pans. Read Medicare & You 2019 You can read the Medicare & You 2019 handbook. Every year in the fa, this booket is maied to peope with Medicare. It has a summary of Medicare benefits, rights and protections, and answers to the most frequenty asked questions about Medicare. If you don t have a copy of this booket, you can get it at the Medicare website ( or by caing MEDICARE ( ), 24 hours a day, 7 days a week. TTY users shoud ca

14 P.O. Box 30006, Pittsburgh, PA SiverScript Customer Care CALL Cas to this number are free, 24 hours a day, 7 days a week. SiverScript Customer Care aso has free anguage interpreter services avaiabe for non-engish speakers. TTY 711 This number requires specia teephone equipment and is ony for peope who have difficuties with hearing or speaking. Cas to this number are free, 24 hours a day, 7 days a week. FAX WRITE WEBSITE SiverScript Insurance Company P.O. Box 6590 Lee's Summit, MO Caremark.com State Heath Insurance Assistance Program A State Heath Insurance Assistance Program (SHIP) is a state program that gets money from the Federa government to give free oca heath insurance counseing to peope with Medicare. You wi find contact information for the SHIP in your state in the Appendix of your Evidence of Coverage.