2016 Group Retiree Medicare Plans

Transcription

1 2016 Group Retiree Medicare Plans Blue Cross MedicareRx (PDP) Medicare Part D Prescription Drug Plans Anthem Blue Cross is a stand-alone prescription drug plan with a Medicare contract. Enrollment in Anthem Blue Cross depends on contract renewal. Y0071_16_24066_I_002 04/06/ MUEENMUB All EGR Drug PAG BR MUEENMUB_002

2 Anthem Blue Cross Medicare Part D Prescription Drug Plans Prescription drug costs can add up quickly. Offer your retirees a plan that helps them stay healthy and keep their prescription costs affordable. Advances in medical and pharmacy treatments have helped to extend both life expectancy and quality of life. Still, with all the advances, according to the Centers for Medicare & Medicaid Services (CMS), hypertension, high cholesterol, heart disease and diabetes are highly prevalent, and most Medicare beneficiaries have multiple chronic conditions. Our medication management programs and $0 copay Select Generic benefit are ways our plans help retirees better manage these chronic conditions. (Source: CMS.gov, Chronic Conditions, 2013.) We offer a variety of formulary and plan options to meet your retirees drug coverage needs Choose from a continuum of Medicare Part D formularies. Choose from one of our standard plans, or work with your account executive to customize a plan for your needs. Coverage that goes beyond paying claims All of our plans are designed to offer benefits above and beyond what retirees can get from Original Medicare. But that s just the beginning. Our mailorder pharmacies offer quality maintenance medications delivered directly to members homes. For added support, our full-service specialty pharmacies connect seniors dealing with chronic, complex conditions with an expansive specialty medication support program that includes patient care advisors, registered nurses and clinical pharmacists. These teams help improve communication between doctors and their patients, and provide an additional level of support not available through a retail pharmacy. Medication Therapy Management program To help improve therapy outcomes for Medicare Part D participants who have chronic diseases or conditions, we offer a comprehensive Medicare Part D Medication Therapy Management (MTM) program. MTM programs are central to Medicare prescription drug plans and strongly supported by Centers for Medicare & Medicaid Services (CMS). Our MTM program: Encourages optimal medication use to help manage conditions, including diabetes and heart disease. Provides information on clinically recognized dosing, administration techniques, drug interactions and typical side effects. Identifies retirees with possible adherence issues and works with the retiree and the retiree s physician to address the issues. Is available to qualified members at no additional cost. Benefits retirees can count on from a trusted source Providing health care solutions to America s retiree population isn t new to us we ve been serving retirees under individual plans for 40 years. All of our Customer Service staff serving our Medicare-eligible population is specially trained in handling the unique needs retirees may have. The charts on the following pages provide a high-level overview of the plans you can choose from for your retirees. Preferred Retail Pharmacy option NEW for 2016! Our Preferred Retail Pharmacy option offers group sponsors an opportunity to save costs while preserving a way for retirees to continue to pay the same copays. Most Standard Part D plans are now available with the Preferred Retail Pharmacy option. With this option, retirees pay the standard plan copay when they obtain their prescriptions from a preferred retail network pharmacy. If they choose to use a standard retail network pharmacy, their copay is $5 higher. Preferred retail pharmacies have agreed to provide additional discounts that reduce your cost. Preferred retail pharmacies include: CVS/pharmacy, Food Lion, Giant Eagle Pharmacy, Hannaford, Harris Teeter Supermarkets, Kroger, Target, Walmart and their affiliates. Not all pharmacy chains are located in every state, and the list of preferred retail pharmacies can change each January. This option is not available to VA groups because of state insurance laws. > select employer groups link

3 Group Retiree Open Formulary Drug Plans with Rich Extra Covered Drugs Drug Benefits Part D Defined Standard Plan 15/30/60 10/30/60/20% up to $100 10/20/40 Member Pays Member Pays Member Pays Member Pays All Part D Coverage Phases N/A Select Generics: $0 Select Generics: $0 Select Generics: $0 Deductible Phase* $360 $0 $0 $0 Retail Pharmacy (Coverage between the member s Initial Coverage limit and true out-of-pocket [TrOOP]) Generics: $15 Non-Preferred Brands & Non-Formulary Drugs: $60 Non-Preferred Brands & Non-Formulary Drugs: $60 Specialty Drugs: 20% up to $100 *** Preferred Brands: $20 Non-Preferred Brands & Non-Formulary Drugs: $40 Mail-order Pharmacy (Coverage between the member s Initial Coverage Generics: $30 Non-Preferred Brands & Non-Formulary Drugs:: $120 Non-Preferred Brands & Non-Formulary Drugs: $120 Specialty Drugs: 20% up to $100*** Preferred Brands: $40 Non-Preferred Brands & Non-Formulary Drugs: $80 TrOOP Limit* (Member out-of-pocket, plus Coverage Gap Discount) $4,850 $4,850 $4,850 $4,850 Catastrophic Coverage Phase* (After TrOOP has been met) Generics: $2.95 or 5%, whichever is greater Brands: $7.40 or 5%, whichever is greater Generics: 5% with a minimum of $2.95 and maximum of $15 Brands: 5% with a minimum of $7.40 Generics: 5% with a minimum of $2.95 Brands: 5% with a minimum of $7.40 Generics: 5% with a minimum of $2.95 Brands: 5% with a minimum of $7.40 and maximum of $20 Supply Amounts Retail 30-day supply 30-day supply 30-day supply 30-day supply Mail-order 90-day supply a 30-day supply and member pays Specialty Drugs which are limited to a 30-day supply a 30-day supply and member pays Extra Covered Drugs** (Medicare-excluded drugs) Cough & cold DESI Vitamins and Minerals Erectile dysfunction Generics: 100% of all drug costs Brands: 100% of all drug costs Generics: Retail and Mail-order copay applies Brands: Retail and Mail-order copay applies Generics: Retail and Mail-order copay applies Brands: Retail and Mail-order copay applies Generics: Retail and Mail-order copay applies Brands: Retail and Mail-order copay applies * The Medicare Part D limits can change on an annual basis. These limits are defined by Centers for Medicare & Medicaid Services (CMS). ** Costs for Extra Covered Drugs do not count toward the member s Medicare Part D limits, and these drugs do not qualify for the lower catastrophic coverage copays and coinsurance amounts. *** Tier 4 mail-order member cost sharing is based on specialty drug fill 30-day supply limit. Not available with Preferred Pharmacy option in Connecticut. Coverage Gap Discount Program: If the member is not receiving help to pay their share of drug cost through the Low Income Subsidy or PACE programs, the member qualifies for the Medicare Coverage Gap Discount Program. For prescriptions filled in 2016, once the cost paid by the member and this retiree drug plan reaches $3,310, the cost share the member pays will reflect all benefits provided by this retiree drug coverage and the Coverage Gap Discount. The Coverage Gap Discount applies until the cost paid by the member and the Discount reaches $4,850. The Medicare Coverage Gap Discount Program reduces the cost of providing your group sponsored retiree drug coverage. Drug Manufacturers have agreed to provide a discount on brand drugs which Medicare considers Part D-qualified drugs. These plans cover some brand drugs beyond those covered by Medicare. The discount will not apply to benefits described in the Extra Covered Drugs section of this chart. 1

4 Group Retiree Comprehensive Closed Formulary Drug Plans Drug Benefits Part D Defined Standard Plan 8/25/55/33% Generic Gap** 10/30/60/30% Up to $100 10/25/40 Member Pays Member Pays Member Pays Member Pays All Part D Coverage Phases N/A Select Generics: $0 Select Generics: $0 Select Generics: $0 Deductible Phase* $360 $0 $0 $0 Retail Pharmacy (Coverage between the member s initial coverage Generics $8 Preferred Brands $25 Non-Preferred Brands: $55 Tier 1 Generics: $8 All Other Non- Specialty Drugs: 30% up to $100*** Preferred Brands: $25 Non-Preferred Brands: $40 Mail-order Pharmacy (Coverage between the member s initial coverage Generics: $16 Preferred Brands: $50 Non-Preferred Brands: $110 Tier 1 Generics: $16 All Other Non-Preferred Brands: $120 Specialty Drugs: 30% up to $100*** Preferred Brands: $50 Non-Preferred Brands: $80 True Out-Of-Pocket (TrOOP) Limit* (Member out-of-pocket, plus Coverage Gap Discount) $4,850 $4,850 $4,850 $4,850 Catastrophic Coverage Phase* (After TrOOP has been met) Generics: $2.95 or 5%, whichever is greater Brands: $7.40 or 5%, whichever is greater and maximum of $8 and maximum of $25 and maximum of $25 Supply Amounts Retail 30-day supply 30-day supply 30-day supply 30-day supply Mail-order 90-day supply Specialty Drugs which are limited to a 30-day supply Specialty Drugs which are limited to a 30-day supply Specialty Drugs which are limited to a 30-day supply and member pays * The Medicare Part D limits can change on an annual basis. These limits are defined by Centers for Medicare & Medicaid Services (CMS). ** This plan may not be available in all states. Some states cap member cost share below the levels used in this plan. *** Tier 4 mail-order member cost sharing is based on specialty drug fill 30-day supply limit. Coverage Gap Discount Program: If the member is not receiving help to pay their share of drug cost through the Low Income Subsidy or PACE programs, the member qualifies for the Medicare Coverage Gap Discount Program. For prescriptions filled in 2016, once the cost paid by the member and this retiree drug plan reaches $3,310, the cost share the member pays will reflect all benefits provided by this retiree drug coverage and the Coverage Gap Discount. The Coverage Gap Discount applies until the cost paid by the member and the Discount reaches $4,850. The Medicare Coverage Gap Discount Program reduces the cost of providing your group sponsored retiree drug coverage. Drug Manufacturers have agreed to provide a discount on brand drugs which Medicare considers Part D-qualified drugs. 2

5 Group Retiree Lower Cost Closed Formulary Drug Plans Drug Benefits Part D Defined Standard Plan 5/15/35/70/ Generic Gap** 8/30/60/33% Generic Gap** 15/45/45/45 Member Pays Member Pays Member Pays Member Pays All Part D Coverage Phases N/A Select Generics: $0 Select Generics: $0 Select Generics: $0 Deductible Phase* $360 $0 $0 $200 Retail Pharmacy (Coverage between the member s initial coverage Preferred Generics: $5 Non-Preferred Generics: $15 Preferred Brands: $35 Non-Preferred Brands: $70 Specialty Drugs: Preferred Generics: $5 Non-Preferred Generics: $15 All Other Generics: $8 Non- Tier 1 Generics: $8 All Other Generics: $15 Preferred Brands: $45 Non-Preferred Brands: $45 Specialty Drugs: $45 Mail-order Pharmacy (Coverage between the member s initial coverage Preferred Non-Preferred Generics: $30 Preferred Brands: $70 Non-Preferred Brands: $140 Specialty Drugs: Preferred Non-Preferred Generics: $30 All Other Generics: $16 Non-Preferred Brands: $120 Tier 1 Generics: $16 All Other Generics: $30 Preferred Brands: $90 Non-Preferred Brands: $90 Specialty Drugs: $45*** True Out-Of-Pocket (TrOOP) Limit* (Member out-of-pocket, plus Coverage Gap Discount) $4,850 $4,850 $4,850 $4,850 Catastrophic Coverage Phase* (After TrOOP has been met) Generics: $2.95 or 5%, whichever is greater Brands: $7.40 or 5%, whichever is greater and maximum of $5 and maximum of $35 and maximum of $8 and maximum of $15 and maximum of $45 Supply Amounts Retail 30-day supply 30-day supply 30-day supply 30-day supply Mail-order 90-day supply a 30-day supply Specialty Drugs which are limited to a 30-day supply a 30-day supply and member pays * The Medicare Part D limits can change on an annual basis. These limits are defined by Centers for Medicare & Medicaid Services (CMS). ** This plan may not be available in all states. Some states cap member cost share below the levels used in this plan. *** Tier 4 mail-order member cost sharing is based on specialty drug fill 30-day supply limit. Not available with Preferred Pharmacy option in Connecticut. The plans on this page cover only a small number of Non-Preferred Brand drugs. The plans shown on prior pages cover a comprehensive list of Brand drugs. Coverage Gap Discount Program: If the member is not receiving help to pay their share of drug cost through the Low Income Subsidy or PACE programs, the member qualifies for the Medicare Coverage Gap Discount Program. For prescriptions filled in 2016, once the cost paid by the member and this retiree drug plan reaches $3,310, the cost share the member pays will reflect all benefits provided by this retiree drug coverage and the Coverage Gap Discount. The Coverage Gap Discount applies until the cost paid by the member and the Discount reaches $4,850. The Medicare Coverage Gap Discount Program reduces the cost of providing your group sponsored retiree drug coverage. Drug Manufacturers have agreed to provide a discount on brand drugs which Medicare considers Part D-qualified drugs. 3

6 MUEENMUB_002 CA All EGR Drug PAG BR Notes that Apply to All Standard Part D Plans 1) If a member purchases drugs at any retail or mail-order pharmacy that is not listed in our network pharmacy directory, the member will be responsible for all amounts over our negotiated cost. 2) Extra Covered Drug benefits are non-medicare supplemental benefits. The costs for these drugs do not count toward the Medicare Part D limits (initial coverage, and these drugs do not qualify for the lower catastrophic coverage copays and coinsurance amounts. 3) Vaccines may be obtained and administered from the pharmacy or doctor s office. One copay will be applied for the purchase and administration of a vaccine, even if billed separately. Members will be liable for any provider charges over our negotiated administration allowance. 4) Medicare limits (initial coverage limit, TrOOP and catastrophic copays) change each calendar year. The limits shown apply to 2016 benefits. 5) The Group Medicare plans shown in this brochure include Medicare Part D drug benefits and non-medicare supplemental drug benefits. CMS approves the Medicare Part D benefits and for insured coverage, the non-medicare supplemental benefits are approved by your state insurance department. Members only need to use one ID card to access all benefits at a network retail or mail-order pharmacy. Medicare parameters for January 1, 2016, as of April The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 4