How Prescription Advantage Works For You

Assistance with Co-payments

Prescription Advantage will provide supplemental coverage for members enrolled in Medicare prescription drug plans. Assistance with co-payments is based on annual household income. There is no separate monthly premium for Prescription Advantage membership, but members are required to pay the Part D premium amounts that their Medicare Drug Plan bills them for.

Annual Out-of-Pocket Spending Limit

Prescription Advantage provides an annual out-of-pocket spending limit. Once this limit is reached, Prescription Advantage will cover prescription drug co-payments for the remainder of the plan year.

Formulary

Prescription Advantage will provide assistance only for drugs covered by a member's Medicare prescription drug plan (Part D), Medicare Advantage plan or Creditable Coverage plan.

Plan Year

The Prescription Advantage plan year runs from January 1 - December 31 of each year.
For members who reach their annual out-of-pocket spending limit, Prescription Advantage covers drug co-payments for the rest of the plan year.

Please download the schedule guide for more information:

For more information on how Prescription Advantage will work with Medicare prescription drug plans, see "How Prescription Advantage Works with Medicare's Prescription Drug Coverage (Part D)".

For Members with Creditable Coverage

For members enrolled in creditable coverage plans, coverage that is equal to or better than Medicare prescription drug coverage, Prescription Advantage may provide assistance with plan co-payments. Members in creditable coverage plans are responsible for their plan's monthly premiums. There is no separate monthly premium for Prescription Advantage membership.

For Members Not Eligible for Medicare

Deductible and Co-payments

Deductible and co-payments are based on annual household income. There is no monthly premium for Prescription Advantage membership. When you purchase prescription drugs, you first satisfy your deductible, then you pay a modest co-payment. Some members may qualify to have part or all of their deductibles waived, depending on their annual household income.

Annual Out-of-Pocket Spending Limit

Prescription Advantage provides an annual out-of-pocket spending limit. Once the amount you have paid in deductible and co-payments reaches your annual out-of-pocket spending limit, Prescription Advantage will cover prescription drug co-payments for drugs that are on the plan formulary for the remainder of the plan year.

Formulary

The Prescription Advantage formulary, for members not eligible for Medicare, includes most prescription drugs.

The formulary for non-Medicare members in Prescription Advantage categorizes prescription drugs into three categories: generic drugs, brand-name drugs, and additional brand-name drugs. Generic drugs have the lowest co-payment, while additional brand-name drugs have the highest co-payment. The Plan's formulary covers most outpatient oral prescription drugs, including insulin and disposable insulin syringes with needles.

To learn more about the medications covered by the Plan, please review the Prescription Value Guide for non-Medicare members.

Plan Year

The Prescription Advantage plan year runs from January 1 - December 31 of each year. For members who reach their annual out-of-pocket spending limit, Prescription Advantage pays the full cost of their covered prescription drugs through the end of the plan year.

Please read Prescription Advantage Rate Schedule Guide for Members Not Eligible for Medicare  pdf format of PA Rate Sch. Guide - Members Not Eligible for Medicare
doc format of                             PA Rate Sch. Guide - Members Not Eligible for Medicare                for more information.

Mail Order for Non-Medicare Members

Use the Mail Order Form to fill your prescriptions with our mail order provider, Prescription Mart.

For More Information

Call 1-800-AGE-INFO (1-800-243-4636)
TTY 1-877-610-0241
Customer Service Representatives are available to answer your questions Monday-Friday, 9 AM - 5 PM EST