Commonwealth Community Care

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Pharmacy Program » Prescription Coverage

Prescription Coverage

Cost-sharing, premiums & deductibles

Here’s some important information about Commonwealth Care Alliance Senior Care Options program (HMO SNP) pharmacy and drug coverage.

Cost
As a Commonwealth Care Alliance member, you have no out-of-pocket expenses for your prescription drug coverage.

Formulary
We will cover the drugs listed in our formulary as long as they are medically necessary. Drugs in the Commonwealth Care Alliance formulary are selected with the help of a team of healthcare providers. These drugs are organized into different drug “tiers” or groups of different drug types.

Medicare
Commonwealth Care Alliance is a Medicare and MassHealth contractor offering prescription and over-the-counter drug benefits. Enrollment entitles you to coverage of those drugs and over-the-counter items that you would normally receive under Medicare and MassHealth.

Please keep in mind:

  • Medicare Part A: covers hospital care drugs
  • Medicare Part B: covers regular doctor’s visits and drugs
  • Medicare Part D: covers outpatient prescription drugs (see “Explanation of Benefits” below for more detail)

Hospital stays
If you are admitted to a hospital, we will provide your prescription drugs under your medical benefit. When you are released from hospital, we will provide your prescription drugs under your outpatient drug benefit.

Generics and brand name drugs
Please keep in mind that a generic drug has the same active ingredient formula as the brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be safe and as effective as brand name drugs.

Explanation of Benefits
When you use utilize your Medicare Part D benefit, you will receive an Explanation of Benefits, containing information about:

  • the prescription drugs that you get from our programs
  • the amount of money that our programs pay for your drugs
  • how to request an exception and how to appeal our coverage decisions
  • changes that will occur to the drug formulary at least 60 days in the future

 

 H0137_OneCareweb_PresCov-Approved

Last Updated 06/04/2015