Where can I get my medications? Your ConnectiCare drug benefit gives you the choice to use a participating pharmacy or order your prescriptions by mail for home delivery by Express Scripts. Looking for delivery and refills resources for individual or employer-sponsored plans? Click here Retail Pharmacies
Full Answer
How do I order from ConnectiCare OTC?
Visit connecticare.com/mailOTC to select your covered items and complete the checkout process. By mail – just fill out and send the mail-order form below to NationsOTC. Mail order items should be received in the mail within two to five business days from the time of receipt of your order.
What if ConnectiCare doesn’t Cover my Drug?
If you learn that ConnectiCare does not cover your drug, you have two options: You can ask member services for a list of similar drugs that we cover. Then show the list to your doctor and ask for a prescription for a similar drug that we cover.
Where can I get a Medicare ConnectiCare concierge advocate?
Our ConnectiCare Medicare Connect Concierge advocates are available 8 a.m. to 8 p.m., seven days a week. Call 800-224-2273 (TTY: 711) or visit a ConnectiCare Center. SilverSneakers can help you live a healthier, more active life. A choice of more than 16,000 fitness locations nationwide.*
Does ConnectiCare Medicare Advantage cover over-the-counter items?
When your ConnectiCare Medicare Advantage plan includes the over-the-counter (OTC) benefit, yo u can get covered for the OTC items below. Your benefit amount and how you get your OTC items and supplies depends on the plan you join. Which over-the-counter (OTC) items does ConnectiCare cover?
Does ConnectiCare use Express Scripts?
This is a reminder that Express Scripts (ESI) is now performing most drug utilization management services for ConnectiCare commercial plan members, including those with plans sold through Access Health CT.
Is ConnectiCare considered Medicare?
ConnectiCare, Inc. is an HMO/HMO-POS plan with a Medicare contract.
Why is my prescription not covered by insurance?
In most cases, your doctor won't know every medication covered under your insurance plan's formulary and could write a prescription for something not covered. There are simply too many different health plans. Check your plan's website or call your plan for a full list of covered medications.
What is UMR specialty pharmacy?
OptumRxTM Specialty Pharmacy provides patients with comprehensive and coordinated delivery and support services related to high-cost oral or injectable medications, which are used to treat complex chronic conditions.
Can ConnectiCare be used out of state?
If you are out of the service area, you will be required to obtain a bill from the doctor. If you are out of the country, the bill should be translated into English and the charges into American dollars. The bill may then be submitted to ConnectiCare for a refund, using the Out-of-Plan Reimbursement Form.
Who owns ConnectiCare?
ConnectiCare Capital, LLCConnectiCare / Parent organization
Can insurance deny prescriptions?
An insurance company may deny payment for a prescription, even when it was ordered by a licensed physician. This may be because they believe they do not have enough evidence to support the need for the medication.
Do pharmacies have to accept GoodRx coupons?
Are pharmacies required to accept GoodRx coupons? Participating pharmacies are required to accept GoodRx through contracts with their pharmacy benefit managers (PBMs). An exception is for controlled medications. Accepting a GoodRx coupon for a controlled medication is always at the discretion of the pharmacist.
Why is my prescription more expensive with insurance?
Every health insurance plan has its policy when it comes to prescription coverage. The breakdown of costs associated with prescription drugs may vary by plan. Depending on your plan structure, you may pay more for your medication if your plan requires you to pay a set copayment to the pharmacy for your medication.
What is OptumRx pharmacy?
OptumRx® is a full-service prescription drug benefit provider with a broad network of retail chain and independent pharmacies, Optum Specialty Pharmacy, and a mail service pharmacy through OptumRx home delivery.
Is UMR and UnitedHealthcare the same?
UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. As a UnitedHealthcare company, UMR has long been a pioneer in revolutionizing self-funding. We focus on delivering customer solutions that meet their goals and strategies.
What pharmacies can I use with OptumRx?
OptumRx is your CalPERS pharmacy benefit manager for Anthem, Health Net, Sharp, UnitedHealthcare, and Western Health Advantage.
Your pharmacy benefits
Our network has more than 60,000 pharmacies, including many national chain pharmacies. Find a participating pharmacy, see which drugs are covered by your plan, set up prescription delivery and refills, and find additional support.
mtm program
Find out if you qualify for this service program which is provided at no additional cost for eligible ConnectiCare Medicare Advantage plan members who have Part D prescription drug coverage.
PRESCRIPTION DRUG COVERAGE
Medicare Advantage members can find out how to file a grievance or an appeal, or request coverage decisions and determinations.
Help and support
Learn about prescription coverage determinations, medication safety, and more.
Your pharmacy benefits
Our network has more than 60,000 pharmacies, including many national chain pharmacies. Find a participating pharmacy, see which drugs are covered by your plan, set up prescription delivery and refills, and find additional support.
Medication Adherence
Taking your medicine as directed by your doctor or pharmacist is one of the most important things you can do for your health and gives you the best opportunity to manage your condition.
Help and support
Learn about prescription coverage determinations, medication safety, and more.
Which Drugs are Covered By My Plan?
You can see the list of drugs covered by your plan below. This drug list is also known as a formulary.
Plans Through Access Health CT
For individuals and families who do not get their insurance through their Employer or Medicare.
Employer-Sponsored Plans
For individuals and families who get their insurance through their employer.
What is a formulary in Medicare 2021?
2021 Medicare formularies. A formulary is the list of prescription drugs covered by ConnectiCare under your plan. If a drug is not in the formulary, then it is not covered (exceptions may apply). A complete list of covered drugs is available below.
What is the number to call for out of network pharmacy?
drugs requested as exceptions. You may call our member services at 1-800-224-2273 (TTY: 711) between 8:00 a.m. and 8:00 p.m..
Does ConnectiCare cover medication?
If you learn that ConnectiCare does not cover your drug, you have two options: You can ask member services for a list of similar drugs that we cover.
How to contact ConnectiCare for Medicare?
To find out more about the MTM Program, you can call ConnectiCare's Medicare Pharmacy Services toll-free at 1-888-447-0321 (TTY: 711) , Monday through Friday, 9 a.m. to 5 p.m., Eastern.
What is MTM in Medicare?
Medication Therapy Management (MTM) program. The MTM Program is a free service for ConnectiCare Medicare plan members with a Part D prescription drug coverage who have certain health conditions and who take a certain number of prescription medications covered by Medicare Part D.
How often do you have to review your prescriptions?
Your medications can be reviewed every four months. After each review, we may send your doctor a letter explaining any issues or ways to improve. Your prescriptions will not change unless you and your doctor decide to change them. We want to be sure you understand your medications and how to take them.
How long does it take for a pharmacist to review a prescription?
The review may take up to 30 minutes. Receive a personal medication list in the mail.
Is MTM a Medicare benefit?
Participation is voluntary. You can opt out of the program at any time. There is no extra cost for this program. While not considered a Medicare benefit, the MTM program is a special service part of your Medicare plan.
Member Portal
Update your contact information, see your benefits, view claims, and more.
Wellness Extras
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Did you find what you're looking for?
Our ConnectiCare Medicare Connect Concierge advocates are available 8 a.m. to 8 p.m., seven days a week.
Which over-the-counter (OTC) items does ConnectiCare cover?
Our plan covers CMS-approved over-the-counter (OTC) health-related items. Certain brands are included. Eligible health categories include:
How to get your eligible items once you activate your OTC card
At participating retail locations, including CVS, Family Dollar, Rite Aid, Walgreens, Walmart, and many others. Check participating locations at otcnetwork.com or call Connect Concierge and we will find a location near you.
Here are ways to order your items for your mail order only OTC benefit
Visit connecticare.com/mailOTC to select your covered items and complete the checkout process.
How to get reimbursed
We ask that you use your benefit in one of the ways listed above. If you are unable, you can request a refund using the below form. Simply mail your completed paper claim form to us with a copy of the receipt (s) for the covered item (s) you bought. We will send you a refund check in the mail.
What is ConnectiCare in Connecticut?
ConnectiCare is a managed care company and subsidiary of New York–based healthcare insurer, EmblemHealth. It offers Medicare Advantage (Part C) plans to people who live in Connecticut. The ConnectiCare network of providers, including general practitioners and specialists, can be found throughout the entire state of Connecticut ...
What is ConnectiCare Flex?
Like all HMOs that include a Point-of-Service (POS) option, ConnectiCare Flex plans give you the ability to use out-of-network providers throughout the United States. There are three Flex plan levels, indicated by numbers 1, 2, and 3. All three plans are available in all eight Connecticut counties.
What is a Part C plan?
What is Part C? Takeaway. at a glance. ConnectiCare is a managed care company that provides Medicare Advantage (Part C) plans throughout Connecticut. Every ConnectiCare Part C plan covers as least as much as original Medicare, plus some extras like prescription drug, dental, and vision coverage.
Does ConnectiCare offer Medicare Part D?
As discussed above, certain ConnectiCare Advantage plans include Medicare Part D prescription drug coverage. ConnectiCare doesn’t sell any stand-alone Part D plans. You must use ConnectiCare in-network pharmacies to get the most coverage for your prescription medications. Like all Medicare plans that provide prescription drug coverage, ...
Do you have to enroll in Medicare to get a Part C?
To buy a Part C plan, you must first enroll in original Medicare. By law, Part C plans are required to cover at least as much as original Medicare. Many Part C plans, including some ConnectiCare plans, also cover extras that original Medicare doesn’t. These extras may include:
Does ConnectiCare cover prescriptions?
ConnectiCare’s plans vary in terms of copays, deductibles, and covered services. Some, but not all, ConnectiCare Part C plans include prescription drug coverage.