The prescription drug coverage for Medicare-eligible retirees and their Medicare-eligible spouse and/or dependents in the GIC's UniCare State Indemnity Plan/Medicare Extension (OME), and effective July 1, 2017 for Harvard Medicare Enhance, Health New England MedPlus and Tufts Medicare Complement, is provided by SilverScript. The plan combines a standard Medicare Part D prescription drug plan with additional coverage provided by the GIC. See these FAQs answers to questions about this prescription drug plan.
Updated on July 13, 2017.
SilverScript Employer PDP sponsored by The Group Insurance Commission
SilverScript Employer PDP sponsored by The Group Insurance Commission (SilverScript) is a Medicare Part D prescription drug plan which is sponsored by the GIC for Medicare-eligible retirees and/or their Medicare-eligible spouse and dependents in the Harvard Medicare Enhance, Health New England MedPlus, Tufts Medicare Complement, and UniCare State Indemnity Plan/Medicare Extension (OME) plans
SilverScript is offered by SilverScript® Insurance Company which has a contract with Medicare and is affiliated with CVS Caremark™, the GIC’s pharmacy benefit manager.
"Employer PDP" Definition
Employer PDP” is the Medicare terminology for an Employer-provided Medicare Part D Prescription Drug Plan.
An “EGWP” is an Employer Group Waiver Plan, a Medicare Part D plan provided by an employer. This type of plan is commonly paired with an employer-provided “wrap” plan that provides additional coverage to close the gaps between the standard Medicare Part D plan and the members’ current coverage from the employer. With the wrap, the employer-provided EGWP provides greater coverage than a standard Medicare Part D plan.
Medicare Part D
Medicare Part D is Medicare prescription drug coverage that helps to cover the cost of prescription drugs for anyone who is eligible for Medicare Part A and/or Medicare Part B. It is provided through private insurance companies, health plans or employer plans like the GIC.
Why the GIC changed its prescription drug coverage for all Medicare members
The GIC moved members of its remaining Medicare supplement plans (Harvard Medicare Enhance, Health New England MedPlus, and Tufts Medicare Complement) to SilverScript effective July 1, 2017 so that the Commonwealth and its retirees can save money on rising prescription drug costs while maintaining current benefits.
What the benefit is to me as a member of the plan
Prescription drug costs are skyrocketing due to the high costs of new specialty medications and industry consolidation that is helping to drive up the costs of both brand name and generic drugs. The money saved by the GIC through this program can help to maintain your current prescription drug benefits despite these rising costs. Members enrolled in the plan who have limited or low income will now be able to take advantage of special programs, such as Medicare’s Extra Help program, that cover some or all of their premium and/or out-of-pocket cost.
Who is covered by the GIC’s SilverScript plan
To be eligible for SilverScript sponsored by the GIC, you must:
- Be eligible for Medicare Part A for free and enrolled in Medicare Part B; and
- Live in the SilverScript service area which is the United States and its territories; and
- Be a GIC retiree, survivor, or a covered spouse/dependent of a GIC retiree; and
- Be enrolled in Harvard Medicare Enhance, Health New England MedPlus, Tufts Medicare Complement or UniCare State Indemnity Plan/Medicare Extension (OME); and
- Continue to pay your Medicare Part B premium, and if required by Medicare because of your income, the Part D surcharge (called the D-IRMAA); and
- Meet and maintain any of the GIC’s eligibility requirements for the plan.
The prescription drug change will affect your premiums
Your GIC premiums for coverage effective July 1, 2017 reflect the EGWP program and are lower than they would have been if the GIC did not move your prescription drug benefits to EGWP.
How your income affectx what you have to pay for your Medicare coverage
If your modified adjusted gross income reported on your federal tax return is above a certain amount, Medicare requires that you pay an extra amount for your Medicare coverage. It is called an Income-Related Monthly Adjustment Amount or IRMAA. For Medicare Part D, it is referred to as “D-IRMAA.”
For 2017, if your modified adjusted gross income from 2015 is over $85,000 for an individual or $170,000 for a married couple filing jointly, you must pay this D-IRMAA. You will be notified by Social Security if you have to pay this additional amount. Some people are currently paying an extra amount for their Part B coverage. If so, they most likely will also be required to pay this D-IRMAA.
The D-IRMAA amount is deducted from your Social Security payment or you will be billed by Medicare. If required, it is important that you pay this additional amount of $13.30 to $76.20 month, depending on income. If you don’t, Medicare will disenroll you from the plan. If you are disenrolled from SilverScript, you will lose your GIC medical, prescription drug and behavioral health benefits.
How to enroll in the GIC-sponsored SilverScript plan
You will automatically be enrolled in the GIC-sponsored SilverScript plan by the GIC if you are enrolled in Harvard Medicare Enhance, Health New England MedPlus, Tufts Medicare Complement or the UniCare OME plan.
When your coverage in SilverScript starts
Your coverage in SilverScript began on July 1, 2017, if you are eligible for Medicare and enrolled in Harvard Medicare Enhance, Health New England MedPlus, or Tufts Medicare Complement. UniCare OME members were enrolled in this program effective January 1, 2016.
If you, your spouse or a dependent become eligible for Medicare after July 1, 2017, the newly Medicare-eligible member will receive a mailing from the GIC to enroll that person in the plan.
Why you and your spouse are both getting information from SilverScript
Medicare is an individual benefit. That means that every person has his or her own account with Medicare. Each person in your family who is eligible for Medicare will receive his or her own documents and his or her own ID card from SilverScript.
When you get your prescriptions filled, you need to make sure you use your own ID card and your spouse needs to use his or her own ID card to get his/her prescriptions filled.
What happens to your spouse or your dependent who is covered on your plan but is not eligible for Medicare
Your covered spouse and/or your covered dependent who is not eligible for Medicare will continue to be covered under the non-Medicare prescription drug plan. He or she should continue to use the same prescription drug ID card that he or she is currently using.
What happens to your coverage if you are enrolled in another Part D plan
You can be enrolled in only one Medicare prescription drug plan at a time. If you are enrolled in another Medicare prescription drug plan or a Medicare Advantage plan with or without prescription drug coverage, you will be disenrolled from that plan when you enroll in a GIC Medicare plan.
Likewise, if you enroll in another Medicare prescription drug plan or a Medicare Advantage plan with or without prescription drug coverage, you will be disenrolled from the GIC-sponsored SilverScript plan. If you are disenrolled from SilverScript, you will lose your GIC medical, prescription drug and behavioral health coverage.
Extra Help is a Medicare program that helps individuals who have low income and resources to pay for prescription drug costs. For 2017, you may qualify if you have
- No more than $18,090 in income or $13,820 in resources for an individual
- No more than $24,360 in income or $27,600 in resources for a married couple
How to find out if you are eligible for Extra Help from Medicare
If Medicare identifies you as a person who qualifies for Extra Help to pay for your prescription drug costs, you will receive a letter from Medicare or the Social Security Administration.
Some people automatically qualify for Extra Help, for instance if they have full Medicaid coverage, get help from Medicaid to pay their Part B premiums or if they receive Supplemental Security Income (SSI) benefits.
To see if you qualify for Extra Help, you can:
- Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Available 24 hours a day, 7 days a week.
- Go online at Medicare’s Website.
- Call Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
- Go online at Social Security’s Website.
How Extra Help works with your GIC coverage
If you qualify for Extra Help, your prescription drug costs will be reduced. Extra Help copays range from $0 to 15% coinsurance. The Low Income Subsidy Rider, which will be included with your SilverScript ID card that you will receive in June, will tell you the exact amount of your copay or coinsurance in 2017.
You will pay the lower of:
- Your Extra Help copay or coinsurance
- Your GIC copay
What to do if you are in a nursing home on Medicaid, and the nursing home wants you to enroll in a Part D Plan different from SilverScript
You should choose the Medicare Part D plan that is best for you. You may want to check to make sure that the nursing home’s pharmacy is a SilverScript network pharmacy. Keep in mind that if you opt out of the SilverScript plan, you will lose your GIC health plan.
Your spouse cannot enroll in the GIC SilverScript plan on his/her own if you are the retiree covered under the GIC and are already enrolled in a non-GIC Part D plan
The GIC does not offer spouse-only health coverage.
You may enroll in one of the GIC’s other Medicare plan options if you don’t want to be enrolled in SilverScript
You can change your health plan option during Annual Enrollment. However, effective July 1, 2017, all GIC Medicare plans include Medicare Part D coverage. Additionally, all GIC Medicare supplement plans – Harvard Medicare Enhance, Health New England MedPlus, Tufts Medicare Preferred, and UniCare OME – are administered by SilverScript.
Different Medicare Part D stages
You do not have to worry about the different stages of Medicare Part D. The additional coverage provided by the GIC covers the gaps between Medicare Part D and your current coverage. Just remember that you pay the same copay you currently pay through all the Medicare Part D stages.
Once you reach Medicare’s out-of-pocket $4,850 maximum, you pay the lower of your current copay or Medicare’s catastrophic coverage coinsurance or copayment.
What to pay when you get your prescription filled at a network pharmacy
You pay your GIC Tier 1, Tier 2 or Tier 3 prescription drug copay whenever you get your prescription filled at network pharmacies.
A formulary is a list of brand name and generic drugs covered by the plan. You will receive a list from SilverScript of the drugs covered by the Medicare Part D portion of the plan.
What to do if your drug is not on the formulary you receive from SilverScript
For drugs not listed on the formulary, call SilverScript at 1.877.876.7214 to find out if it is covered. TTY users should call 711. Some drugs are covered through the GIC’s additional coverage.
Additional coverage from the GIC
The additional coverage from the GIC fills the gap between the standard Medicare Part D plan and your current coverage:
- Paying the difference in cost between your current copay and what a standard Medicare Part D plan would pay. You have no deductible and no coverage gap or “donut hole.”
- Covering drugs not on SilverScript’s standard drug list or formulary
- Covering certain drugs that are not covered by Medicare Part D
Examples of drugs that are not covered by a standard Medicare Part D plan that will be covered under the GIC’s extra coverage
The following are examples of some of the drugs that will not be on the Part D formulary you receive in May from SilverScript, but will be covered by the GIC’s extra coverage:
- Prescription drugs for anorexia, weight loss or weight gain
- Prescription drugs for the symptomatic relief of cough or cold
- Prescription vitamins and mineral products not covered by Part D
- Prescription drugs for treatment of sexual or erectile dysfunction
- Certain diabetic drugs and supplies not covered by Part D
- Prescription drugs for tobacco cessation
- Part B products, such as oral chemotherapy agents.
"Transition Fill" definition
A transition fill is a 30 day fill for a medication that is not covered under the SilverScript Medicare Part D formulary. The first fill will be restricted to a 30-day supply for a medication that is not covered by the Medicare Part D formulary within the first 90 days the member is effective in a plan. Some drugs may be covered for a 90-day supply through your GIC benefit after the first 30-day supply is obtained. For further clarification on transition fill, or to see if you can acquire a 90-day supply after a transition fill, contact SilverScript.
Medications that may be covered under your current GIC Medicare plan that will not be covered under the SilverScript program
The SilverScript program does not cover Over-the-Counter (OTC) medications. OTC medications to treat conditions such as allergies (generic Allegra and Claritin) and heartburn (Nexium 24 hour) are not covered. The SilverScript plan also limits the dosing strength of sleeping agents (generic Restoril).
Why you received a letter from SilverScript saying that you are taking a drug that is not covered
Medicare requires that SilverScript send you a letter if a drug you are taking is not on the SilverScript Medicare Part D formulary, even if that drug is covered by the GIC’s extra coverage. If you receive one of these letters, please call SilverScript at 1.877.876.7214 to determine if the drug is covered by the extra GIC coverage. Common drugs not covered by Part D, but covered by the GIC extra coverage, include: Clotrimazole/Betamethasone Cream, Glyburide, Nystatin/Triamcinolone, Lunesta and Carisoprodol.
You may continue to pay less than the GIC Tier 1 copay under the SilverScript program if you are currently taking a generic medication and pay less than the Tier 1 copay
As always, if the actual cost of the drug is less than your copay, you pay the lower cost. However, for some members, the actual cost of their generic drug may be higher than it was through your current Medicare drug program. This difference in cost is due to SilverScript having a different drug list and pricing than your current Medicare drug program. Despite the difference in price, you will pay no more than the copay for that drug and in many cases your cost will still be less than the copay.
You can use any SilverScript network retail and mail order pharmacies, as well as long-term care and home infusion pharmacies
Visit SilverScript’s website, or call SilverScript at 1.877.876.7214 to find the network pharmacies near you. TTY users should call 711.
Preferred network pharmacies
SilverScript has preferred network retail pharmacies where you can get up to a 90-day supply of your maintenance medications for the same copay as mail-order. Current preferred network pharmacies include CVS Pharmacy®, Longs Drugs (operated by CVS Pharmacy) and Navarro.
Visit SilverScript’s website at SilverScript's website, or call SilverScript at 1.877.876.7214 to find the preferred network pharmacies near you. TTY users should call 711.
You may continue to get your prescriptions filled at a Veterans Affairs (VA) pharmacy
VA pharmacies are not included in Medicare Part D plan networks. The federal government does not allow anyone to receive benefits from more than one government program at the same time.
However, if you are eligible for VA benefits, you may still use VA pharmacies under your VA benefits. Contact the VA Administration to find out the copay for the drugs you get filled at these facilities and also contact SilverScript for copays at participating SilverScript pharmacies so you can compare the two programs and determine the best option for you.
VA pharmacies are not included in Medicare Part D plan networks including SilverScript. The federal government does not allow anyone to receive benefits from more than one government program at the same time. However, if you are eligible for VA benefits, you may still use VA pharmacies under your VA benefits. Contact the VA Administration to find out the copay for the drugs you get filled and also contact SilverScript for copay details so you can compare the two programs and determine the best option for you. If you go to a retail pharmacy, such as CVS, Walgreens, or any other retail pharmacy, the claim will first process under your SilverScript Medicare Part D benefit, then it will process through TRICARE, where applicable. Questions concerning coordination of benefits, should be directed to TRICARE.
You may get your prescriptions filled at a pharmacy that is not part of SilverScript’s pharmacy network
Prescriptions filled at out-of-network pharmacies are only covered in an emergency. If you have any questions about whether or not your prescription will be covered at an out-of-network pharmacy, call SilverScript at 1.877.876.7214. TTY users should call 711.
If you use an out-of-network pharmacy, you will have to pay the full cost for your prescription and submit a paper claim available on SilverScript’s website and your itemized receipt to SilverScript for reimbursement.
If you regularly travel overseas, you may need to prepare in advance of leaving the country
If you are traveling outside of the country, be sure to bring your prescription medications with you. Currently, Medicare Part D does not offer drug coverage outside of the country. You can call SilverScript at 1.877.876.7214 and request a vacation override for up to a 90-day supply before leaving the country. TTY users should call 711.
What happens if you need to get a prescription filled while you are out of the country
If you are traveling and need to fill a prescription, you should pay for the medication and save the itemized receipt. When you return to the country, send the itemized receipt with the completed SilverScript claim form (available at SilverScript's website) to the GIC and we will arrange to have you reimbursed for the cost of the prescription minus your copay, as long as the prescription is a covered drug and within the requirements of the plan design.
Late Enrollment Penalty for Medicare Part D
The Part D Late Enrollment Penalty (LEP) is the amount that Medicare requires a person to pay if he/she:
- Did not enroll in a Medicare prescription drug plan when first eligible for Medicare; or
- Did not have creditable prescription drug coverage – coverage at least as good as Medicare’s standard plan; or
- Had a break in coverage of more than 63 consecutive days.
You do not have to worry about the late enrollment penalty for Medicare Part D if you have been covered on the GIC’s retiree Medicare health plan since you retired
The GIC’s retiree prescription drug coverage has always met or exceeded Medicare Part D coverage standard and has therefore been considered creditable coverage. See your health plan handbook for a Creditable Coverage notice.
What will happen if you are contacted by SilverScript about a late enrollment penalty
If SilverScript contacts you, they may need information about your past prescription drug coverage to send to Medicare. Please make sure you provide the information requested in the notice. You may also ask that any decision about your late enrollment penalty be reconsidered.
The GIC will pay any Medicare Part D late enrollment penalty for the 2017 transition to SilverScript. But if you decide to cancel your GIC coverage in the future and enroll in a non-GIC Medicare Part D plan, you will be responsible for the Medicare Part D late enrollment penalty.
What you need to do if your drug can be covered under Part B or Part D
Certain drugs may be covered under Part B for some medical conditions and under Part D for other medical conditions. If you take a drug that could be covered under Medicare Part B or Medicare Part D, you will have to get a Part B or Part D determination, a special kind of prior authorization, before the drug can be filled.
Contact SilverScript at 1.877.876.7214. TTY users should call 711.
Medication Therapy Management
- Medicare requires Medicare prescription drug plans to offer an optional, free service called Medication Therapy Management (MTM). If you take multiple medications, have a chronic condition or high drug costs, you may be invited to participate in a MTM program designed for your specific health issue. You may choose not to participate, but you should consider taking advantage of this free service. Contact SilverScript for additional details.
Who to call if you have any questions about Medicare Part D or SilverScript
If you have any questions about Medicare Part D or SilverScript, or you want to find out if your drug is covered or the location of network pharmacies near where you live or you are traveling, contact SilverScript at 1.877.876.7214, 24 hours a day, 7 days a week. TTY users should call 711.
Who to contact if you have questions about eligibility, how to enroll in the plan or your monthly health plan premium
If you have questions about eligibility, how to enroll in the plan, or your premium, contact the GIC at 1.617.727.2310, available 8:45 a.m. to 5:00 p.m., Monday through Friday. TTY users should call 711.
When you transfer to SilverScript, you will I continue to have no copays if you are currently enrolled in another Part D plan and have no copays
If you are on Medicaid, receiving Extra Help from Medicare because you have low income, and/or are in another assistance program, you may continue to have no copays with the SilverScript plan as long as you qualify for the Extra Help program.
If you are not low income, your copays will be the same prescription drug copays as you pay now.