A Healthy CollaborationSM

Frequently Asked Questions For Members

Q: I've heard about the coverage gap. What is this and will it affect me?

You may have heard this referred to as the "donut hole" or the "gap". After your total yearly drug costs–paid by you and PrescribaRx–have reached $2700, you are responsible for paying 100% of your prescription costs until you have paid $4350 in yearly out-of-pocket costs. The coverage gap is a standard guideline set by Medicare. If you think you're nearing the coverage gap, call us and we'd be happy to walk you through your options. Learn more about the coverage gap.

Q: How do I find out if my prescription drugs are covered?

You can check our formulary online by clicking here to find out if your drugs are covered by your PrescribaRx plan. Or feel free to give us a call at the number to the right and we can tell you within minutes.

Q: Can I change to a different PrescribaRx plan for next year?

Yes. If you're interested in changing to a different PrescribaRx plan, such as the Platinum plan that offers coverage on generics during the coverage gap, it's as easy as giving us a call. It's important to remember that you can only switch PrescribaRx plans during the annual enrollment period, November 15–December 31, unless you qualify for a special enrollment period.

Q: I have friends who could benefit from a PrescribaRx plan. How can they learn more?

It's easy. They can call 1-800-765-4576 (TTY for the hearing impaired: 1-800-958-2692) 8 AM to 8 PM, 7 days a week. A PrescribaRx representative will be happy to answer any questions and talk to them about Medicare prescription drug coverage.

Q: How do I start using Eldercare Services?

To take advantage of Eldercare Services' resources and professional assistance, call 1-866-339-6495.

Q: What if my drug is not on the formulary?

If your prescription is not listed on our formulary, you should first contact Member Service to be sure it is not covered. If Member Services confirms that we do not cover your drug, you have three options:

  • PrescribaRx can help you find another drug to treat your medical condition that is part of our formulary.
  • You can ask us to make an exception and cover your drug.
  • You can pay out of pocket for the drug and request that the plan reimburse you.

Q: How can I request an exception to PrescribaRx’s formulary?

You can ask us to make an exception to our coverage rules. Learn how to access our process and form for filing an exception.

Q: What is utilization management?

For certain prescription drugs, PrescribaRx has additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for PrescribaRx to help us to provide quality care to our members. See our examples of utilization management and how you can take advantage of this procedure.

Q: What are my rights and protection under PrescribaRx?

Because you have Medicare, you have certain rights to help protect you. This section will enable you to access explanations of your Medicare rights and protections as a member of PrescribaRx. We will tell you what you can do if you think you are being treated unfairly or your rights are not being respected. Please click here for complete explanations of your rights and protection under PrescribaRx.

Looking for ways to stay healthy? Our PrescribaRx plans offer valuable Wellness Services.

PrescribaRx plans help you save money on your prescription medicines. They also come with personalized help from local pharmacists who can help you save money and better understand your prescription drug regimen. Pharmacists in our network can answer questions about the medicines you take, to help you avoid harmful drug interactions. They can also help you understand your drug plan and find ways to save you money.

Q: Does PrescribaRx have materials that are in Spanish?

Yes, PrescribaRx has Spanish materials, such as the 2009 Enrollment Form and the Summary of Benefits, available. Request Spanish materials or call 1-800-818-0007 (TTY for the hearing impaired: 1-800-777-9083) 8 AM to 8 PM, 7 days a week.


S5597_S5825_C0008_09P0043_v1 (07/2009) Last updated: 6/23/2009

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