Providers treating Viva Medicare patients can use the real-time prescription benefit tool to see drug coverage information, patient cost, up to five alternatives specific to the patient’s plan, and other restriction such as prior authorizations and quantity limits. For more information, click the links below. Resources
Full Answer
Will my drug be covered by a Viva Medicare plan?
Viva Medicare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Viva Medicare network pharmacy, and other plan rules are followed. The formulary may change during the year.
How do I contact a Viva health provider?
If you are a Viva Health Commercial Group Member and you have additional questions about Viva Health providers, please call 1-800-294-7780 (toll free) or 205-558-7474. If you are a Medicare member and you have additional questions about Viva Medicare providers, please call 1-800-633-1542 (toll free) or 205-918-2067.
How do I contact Viva Health Medicare MTM program?
For more information on Viva Health Medicare MTM Program, please contact our member services department at 1-800-633-1542 or 205-918-2067, TTY users call 711. The hours are Monday-Friday, 8 am - 8 pm. From October 1st through March 31st, seven days a week, 8 am - 8 pm.
How do I sign up for CVS Viva Medicare?
To sign up, call the CVS Customer Care Team toll-free number at 1-866-788-5146, Monday - Friday, 7am - 7pm. Need to know where to get your prescriptions? You can view a list of Viva Medicare network pharmacies in the Pharmacy Directory for your plan.
How do you know what tier your medication is?
The easiest way to find out what tier your drugs are in is by using your plan's drug list. When you look up a drug, the second column of the drug list will show you what tier it's in. You can find out more about how to read a drug list in our Help Center. Find your plan's drug list.
How do I get cheaper prescriptions with Medicare?
Lower prescription costsAsk about generic drugs—your doctor can tell you if you can take a generic drug instead of a brand-name drug or a cheaper brand-name drug.Look into using mail-order pharmacies.Compare Medicare drug plans to find a plan with lower drug costs.Apply for.More items...
Does Medicare have copays for prescriptions?
Medicare is a government-funded health insurance option for Americans age 65 and older and individuals with certain qualifying disabilities or health conditions. Medicare beneficiaries are responsible for out-of-pocket costs such as copayments, or copays for certain services and prescription drugs.
How do I know if my medication is covered by insurance?
Call your insurer directly to find out what is covered. Have your plan information available. The number is available on your insurance card the insurer's website, or the detailed plan description in your Marketplace account. Review any coverage materials that your plan mailed to you.
Why are my prescriptions so expensive with Medicare?
Another reason some prescriptions may cost more than others under Medicare Part D is that brand-name drugs typically cost more than generic drugs. And specialty drugs used to treat certain health conditions may be especially expensive.
Can you use GoodRx if you have Medicare?
While you can't use GoodRx in conjunction with any federal or state-funded programs like Medicare or Medicaid, you can use GoodRx as an alternative to your insurance, especially in situations when our prices are better than what Medicare may charge.
What percentage does Medicare pay for prescription drugs?
Medicare will pay 75% of the price for generic drugs during the coverage gap. You'll pay the remaining 25% of the price. The coverage for generic drugs works differently from the discount for brand-name drugs.
What is a copay for prescription?
Copayment, copay or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan.
How do I get my $144 back from Medicare?
Even though you're paying less for the monthly premium, you don't technically get money back. Instead, you just pay the reduced amount and are saving the amount you'd normally pay. If your premium comes out of your Social Security check, your payment will reflect the lower amount.
What is a Tier 2 prescription drug?
There are typically three or four tiers: Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs. Tier 4: Highest cost prescription drugs.
What are Tier 4 prescription drugs?
Copayment Definitions for the Six-Tier FormulariesTier 1The prescription drug tier which consists of the lowest cost tier of prescription drugs, most are generic.Tier 4The prescription drug tier which consists of the higher-cost prescription drugs, most are brand-name prescription drugs, and some specialty drugs.5 more rows
Can I get reimbursed for prescriptions?
Claims filed within 30 days of the prescription being filled can be directly reimbursed through the pharmacy where the prescription was filled/purchased. The plan member will need to present their carrier ID card and a receipt showing the amount they originally paid.
How to contact viva health?
If you have any changes, please email [email protected] or call Viva Health Customer Service at (205) 558-7474 or 800-294-7780. We will then update your information on our website.
When will Viva Health start a step therapy program?
Medical Preferred Drug Program with Step Therapy. Effective January 1, 2021, Viva Health is adding a Medical Preferred Drug Program with Step Therapy requirements for our Commercial Lines of Business. Click here for information about the program.
How long does it take to file a Medicare claim?
Effective March 1st, 2018, Coordination of Benefits claims for all lines of business (i.e., Commercial, Medicare) must be filed within eighteen months from the date of service in order to be considered for secondary payment.
Can Viva Health HCFA be filed electronically?
Coordination of Benefits Update. Viva Health is proud to announce secondary HCFA and UB claims can now be filed electronically for all Commercial , Medicare, and Drummond lines of business. If you have any questions, please feel free to contact our Provider Customer Service department directly at (205) 558-7474.
When will the Affordable Care Act be effective?
The law’s numerous provisions are effective at different times between now and 2020 and some provisions are phased in over a number of years. Click here for the full article.
Does Viva Health have a PA?
In an effort to relieve some of the administrative burdens of our participating provider’s offices, Viva Health has recently made some changes to the prior authorization (PA) requirements for certain procedures/CPT codes . Click here for details.
Is there a fee for changing healthcare?
There is no fee to use Change Healthcare (formerly Emdeon) ePayment. Enrollment is simple and free. By enrolling with Change Healthcare, you can accelerate your reimbursement cycle, eliminate paper based claims payments, sorting mail, and making trips to the bank.
How to find out if a drug is generic or brand?
Click the plan and enter the drug name. Click the dosage you are searching. Click the name of the drug, then "more information". The information displays if the drug is considered "brand" or "generic.". It also displays if the drug is covered or not covered by the plan.
What is a formulary in Medicare?
A formulary represents the prescription therapies believed to be a necessary part of a quality treatment program. Viva Medicare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Viva Medicare network pharmacy, and other plan rules are followed.
What is the CVS pharmacy mail order number?
To sign up, call the CVS Customer Care Team toll-free number at 1-866-788-5146, Monday - Friday, 7am - 7pm.
Does Viva Medicare include prescription drugs?
*Notice for Members of Viva Medicare Select: Your plan does not include prescription drug coverage. Therefore, the formulary and formulary search tools are not applicable to your plan.
How to contact Medicare for a new drug?
Or, you can contact. Medicare's Limited Income Newly Eligible Transition (NET) Program at 1-800-783-1307 for more information (TTY: 711).
What is Medicare copay?
This program helps pay for your Medicare drug coverage, such as plan premiums, deductibles, and costs when you fill your prescriptions, called copays or coinsurance.
How to lower prescription costs?
To lower your prescription drug costs, you can: Ask about generic drugs—your doctor can tell you if you can take a generic drug instead of a brand-name drug or a cheaper brand-name drug. Look into using mail-order pharmacies. Compare Medicare drug plans to find a plan with lower drug costs. Apply for.
Is Medicaid covered by Medicare?
Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid. A monthly benefit paid by Social Security to people with limited income and resources who are disabled, blind, or age 65 or older.
Do you qualify for extra help if you have Medicare?
Some people automatically qualify for Extra Help. You'll get the Extra Help program if you have Medicare and get any of the following: A joint federal and state program that helps with medical costs for some people with limited income and resources.
Manage Your Account
The Viva Member Portal allows you to easily manage your account. Helpful features include the ability to check your mailing address, see an electronic version of your member card, request a new member card, and find Viva member services phone numbers easily.
View Your Claims
Easily view a list of your medical and prescription claims and any details you may need to know including provider, copays, coinsurance, and amount paid by your plan.
Read Explanations of Benefits
View explanations of benefits for medical claims and understand what service was provided, what charges were made, covered and not covered, and how to appeal a decision.
Your Pharmacy Benefits via Mobile App
If you have drug coverage through your Viva Health plan (i), our Pharmacy Benefit Manager – Express Scripts® – offers an advanced mobile app that allows you to easily access your pharmacy benefits and take advantage of helpful tools.
Questions?
Do you have questions about your prescription benefits, or a specific question about prior authorizations for retail drugs?
