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Transcript
Staying healthy for less One way to save on prescription drug costs is to switch from a brand name drug to a generic drug used to treat the same condition. Generics are safe and effective because the Food and Drug Administration (FDA) requires that they have the same active ingredient as their brandname equivalent. Generics are also required by the FDA to have the same strength, purity, potency, content uniformity and the time it takes to break down in the body. Why do generics cost less? Generic drug manufacturers do not have to repeat the costly clinical trials required of brand name manufacturers. Also, generic manufacturers do not have to pay to advertise or promote their drug. As a result, generic drugs are much less costly to produce and market. Because of the lower costs, SilverScript is able to offer generic drugs to you with much lower copays and coinsurance amounts. MemberHealth ® NEWS VOLUME 1 / APRIL / 2014 Are generics identical to brand name drugs? Not quite. While generics are required to have the same active ingredient by the FDA, they are not required to have the same “inactive” ingredients such as fillers and dyes. As always, talk with your doctor about any concerns you may have, and any opportunities to switch from a brand name drug to a generic. And remember that an up-to date list of all your prescription drugs and any over-the-counter medications you take will help your doctor evaluate your prescription drug needs. Understanding changes to the drugs we cover (page 2) Some drugs not covered by your Part D Plan may be covered by Medicare Part B (page 3) Staying healthy for less Call SilverScript Customer Care toll free at 1-855-373-5774, 24 hours a day, 7 days a week or TTY call 1-866-684-5351 for questions regarding any of these articles. When online, visit silverscript.com for news, forms, benefit information and member-friendly search tools. (page 4) This information is available for free in other languages. Please call our Customer Care number at 1-855-373-5774, TTY call 1-866-684-5351, 24 hours a day, 7 days a week. Esta información está disponible gratuitamente en otros idiomas. Llame a nuestro servicio al miembro, al 1-855-373-5774. Los usuarios de teléfono de texto (TTY) deben llamar al 1-866-684-5351, las 24 horas del día, los 7 días de la semana. SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. 4 • SilverScript MemberHealth News Y0080_RET_41030_2014 Accepted 00091271 EOB_INSERT_APR14_ENG Understanding changes to the drugs we cover As your prescription drug plan provider, SilverScript is committed to ensuring that our plans continue to offer you safe, effective and affordable prescription drugs. Sometimes that requires us to change the list of drugs we cover (our formulary) during the plan year. Although changes to our drug list generally occur at the beginning of the plan year (January 1), they can occur during other times of the year as well. CHANGES TO OUR DRUG LIST INCLUDE: • Adding a drug to our formulary • Adding or removing a restriction for taking a drug • Moving a drug from its current tier to a higher or lower tier • Replacing a brand name drug with a generic drug • Removing a drug from our formulary Your Evidence of Coverage (EOC) explains what you can do when a drug change affects you Depending on your situation, we may provide you with a temporary supply As a new member, you may find that a drug you take is not covered, or that the brand name is not covered but the generic version is. Or that certain drugs carry usage restrictions. There may be times when we will require you to try a certain drug first before another drug may be approved, or require you and your doctor to submit a request for coverage. All of these examples and actions you can take when a drug change affects you are explained in your EOC booklet. In certain situations, if a drug you take is not on our drug list, you may be able to get a temporary supply called a “transition fill”. A transition fill allows you and your doctor time to discuss the possible use of a different drug that is included on our drug list. Remember that transition fills are always temporary and that not everyone is eligible for a transition fill. For more information about transition fills, see your plan’s EOC. If we make a change to the drugs we cover and the change affects you, we will notify you 60 days in advance before the change takes effect. The only exception would be a sudden recall of a drug for safety reasons. If that happens, we would remove the drug immediately and notify you right away. Call SilverScript Customer Care toll free at 1-855-373-5774, 24 hours a day, 7 days a week or TTY call 1-866-684-5351 for questions regarding any of these articles. When online, visit silverscript.com for news, forms, benefit information and member-friendly search tools. 2 • SilverScript MemberHealth News Some drugs not covered by your Part D plan may be covered by Medicare Part B Medicare Part D covers many prescription drugs, but not all of them. Fortunately, some drugs not covered by Part D are covered by Medicare Part B. The drugs listed here are some examples: • • • Antigens When used to treat allergies Hemophilia Clotting Drugs When self-administered Immunosuppressive Drugs When used for transplant patients • • Oral Anti-Cancer Drugs When administered by you or your doctor Injectable Drugs When administered by your doctor • • • Infusion Drugs When used with an infusion pump Intravenous Immune Globulin When used in the home Inhalation Drugs When used with a home nebulizer Sometimes, Medicare Part B and Part D cover the same drug depending on how the drug is used. For example, an oral anti-cancer drug is covered under Part B if used strictly to treat cancer. If used for a condition other than cancer, it is covered under Part D. For more information about Medicare Part D and Part B, visit www.medicare.gov. April 2014 • 3 Understanding changes to the drugs we cover As your prescription drug plan provider, SilverScript is committed to ensuring that our plans continue to offer you safe, effective and affordable prescription drugs. Sometimes that requires us to change the list of drugs we cover (our formulary) during the plan year. Although changes to our drug list generally occur at the beginning of the plan year (January 1), they can occur during other times of the year as well. CHANGES TO OUR DRUG LIST INCLUDE: • Adding a drug to our formulary • Adding or removing a restriction for taking a drug • Moving a drug from its current tier to a higher or lower tier • Replacing a brand name drug with a generic drug • Removing a drug from our formulary Your Evidence of Coverage (EOC) explains what you can do when a drug change affects you Depending on your situation, we may provide you with a temporary supply As a new member, you may find that a drug you take is not covered, or that the brand name is not covered but the generic version is. Or that certain drugs carry usage restrictions. There may be times when we will require you to try a certain drug first before another drug may be approved, or require you and your doctor to submit a request for coverage. All of these examples and actions you can take when a drug change affects you are explained in your EOC booklet. In certain situations, if a drug you take is not on our drug list, you may be able to get a temporary supply called a “transition fill”. A transition fill allows you and your doctor time to discuss the possible use of a different drug that is included on our drug list. Remember that transition fills are always temporary and that not everyone is eligible for a transition fill. For more information about transition fills, see your plan’s EOC. If we make a change to the drugs we cover and the change affects you, we will notify you 60 days in advance before the change takes effect. The only exception would be a sudden recall of a drug for safety reasons. If that happens, we would remove the drug immediately and notify you right away. Call SilverScript Customer Care toll free at 1-855-373-5774, 24 hours a day, 7 days a week or TTY call 1-866-684-5351 for questions regarding any of these articles. When online, visit silverscript.com for news, forms, benefit information and member-friendly search tools. 2 • SilverScript MemberHealth News Some drugs not covered by your Part D plan may be covered by Medicare Part B Medicare Part D covers many prescription drugs, but not all of them. Fortunately, some drugs not covered by Part D are covered by Medicare Part B. The drugs listed here are some examples: • • • Antigens When used to treat allergies Hemophilia Clotting Drugs When self-administered Immunosuppressive Drugs When used for transplant patients • • Oral Anti-Cancer Drugs When administered by you or your doctor Injectable Drugs When administered by your doctor • • • Infusion Drugs When used with an infusion pump Intravenous Immune Globulin When used in the home Inhalation Drugs When used with a home nebulizer Sometimes, Medicare Part B and Part D cover the same drug depending on how the drug is used. For example, an oral anti-cancer drug is covered under Part B if used strictly to treat cancer. If used for a condition other than cancer, it is covered under Part D. For more information about Medicare Part D and Part B, visit www.medicare.gov. April 2014 • 3 Staying healthy for less One way to save on prescription drug costs is to switch from a brand name drug to a generic drug used to treat the same condition. Generics are safe and effective because the Food and Drug Administration (FDA) requires that they have the same active ingredient as their brandname equivalent. Generics are also required by the FDA to have the same strength, purity, potency, content uniformity and the time it takes to break down in the body. Why do generics cost less? Generic drug manufacturers do not have to repeat the costly clinical trials required of brand name manufacturers. Also, generic manufacturers do not have to pay to advertise or promote their drug. As a result, generic drugs are much less costly to produce and market. Because of the lower costs, SilverScript is able to offer generic drugs to you with much lower copays and coinsurance amounts. MemberHealth ® NEWS VOLUME 1 / APRIL / 2014 Are generics identical to brand name drugs? Not quite. While generics are required to have the same active ingredient by the FDA, they are not required to have the same “inactive” ingredients such as fillers and dyes. As always, talk with your doctor about any concerns you may have, and any opportunities to switch from a brand name drug to a generic. And remember that an up-to date list of all your prescription drugs and any over-the-counter medications you take will help your doctor evaluate your prescription drug needs. Understanding changes to the drugs we cover (page 2) Some drugs not covered by your Part D Plan may be covered by Medicare Part B (page 3) Staying healthy for less Call SilverScript Customer Care toll free at 1-855-373-5774, 24 hours a day, 7 days a week or TTY call 1-866-684-5351 for questions regarding any of these articles. When online, visit silverscript.com for news, forms, benefit information and member-friendly search tools. (page 4) This information is available for free in other languages. Please call our Customer Care number at 1-855-373-5774, TTY call 1-866-684-5351, 24 hours a day, 7 days a week. Esta información está disponible gratuitamente en otros idiomas. Llame a nuestro servicio al miembro, al 1-855-373-5774. Los usuarios de teléfono de texto (TTY) deben llamar al 1-866-684-5351, las 24 horas del día, los 7 días de la semana. SilverScript is a Prescription Drug Plan with a Medicare contract offered by SilverScript Insurance Company. Enrollment in SilverScript depends on contract renewal. 4 • SilverScript MemberHealth News Y0080_RET_41030_2014 Accepted 00091271 EOB_INSERT_APR14_ENG