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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