Who can use our mail-order pharmacy program? You must have prescription drug coverage benefits through Fallon Health to use the mail-order pharmacy program. You can use mail order if you've been on the same medication for several months with no change in dose, and you plan on being on the same medication and dose for a while.
What Medicare Advantage prescription drug plans does Fallon Health offer?
The following Fallon Health plans offer Medicare Advantage Prescription Drug plan coverage to Massachusetts residents. Medicare Advantage plans are an alternative way to get your Original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings.
How do mail-order prescriptions work with Medicare Advantage and Part D?
With all our Medicare Advantage and Part D prescription drug plans, you have access to mail-order prescription services. That means you can order up to three months of your prescription drugs at a time and they'll be delivered right to your house. You usually save money when you order through these services, too.
What kind of insurance is Fallon Health?
•Fallon Health - Fallon Health is an HMO/HMO-POS plan with a Medicare contract. Enrollment in Fallon Health depends on contract renewal. •Fallon Health - This information is not a complete description of benefits.
What is the difference between navicare and Fallon Health?
Fallon Health is an HMO plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Health depends on contract renewal. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS. This information is not a complete description of benefits.
Is OptumRx the same as Caremark?
OptumRx replaced CVS/Caremark on January 1, 2017 in administering prescription drug benefits for about 632,000 CalPERS members and their families.
Who is the PBM for Fallon Community Health Plan?
OptumRxOptumRx will be Fallon Health's new pharmacy benefits manager starting January 1, 2022. A pharmacy benefits manager (PBM) is a company that we partner with to provide your prescription medication coverage and benefits. On January 1, 2022, Fallon Health will be changing our PBM from CVS Caremark to OptumRx.
Does Medicare cover mail-order pharmacy?
In some Medicare plans, your prescriptions are only covered if you get them filled at network pharmacies. Along with retail pharmacies, your plan's network might include preferred pharmacies, a mail-order program, or an option for retail pharmacies to supply a 2- or 3-month supply.
What is mail-order pharmacy?
In mail-order, a healthcare professional sends the prescription to a mail-order pharmacy, which generally works through your insurance company and its pharmacy benefit manager (PBM). Your prescription is filled by the mail-order pharmacy, run through insurance, and the medication is mailed directly to you.
How do I get a mail order prescription?
Ask your doctor to send your prescription directly to the mail order pharmacy. Or fill out an order form on the pharmacy's website and attach your prescription. Get your prescriptions delivered safely and conveniently to your doorstep. They'll usually come as a 90-day supply.
Who is eligible for OptumRx?
Beneficiaries who have an active health insurance plan that includes a pharmacy benefit are eligible to use the retail benefit administered by OptumRx. If you believe your Other Health Insurance information is incorrect, please contact VHA OCC Beneficiary Services at 1-800-733- 8387. I lost my OptumRx Pharmacy ID Card.
Who is OptumRx?
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.
How reliable are mail order pharmacies?
Many large mail-order pharmacies voluntarily meet independent accreditation standards every three years that evaluate their standards for safe medication delivery. But government oversight of mail-order pharmacies is largely a system of blind trust, experts said.
Can you use GoodRx with mail order pharmacy?
About GoodRx As America's leading resource for healthcare savings, GoodRx connects consumers with affordable and convenient prescriptions and medical care, including telehealth, mail-order prescriptions, doctor visits, and lab tests.
Is Express Scripts any good?
Express Scripts has a consumer rating of 1.22 stars from 199 reviews indicating that most customers are generally dissatisfied with their purchases. Consumers complaining about Express Scripts most frequently mention customer service, local pharmacy and several times problems.
Do I have pharmacy benefits?
Whether or not you have pharmacy benefits through Fallon Health depends on the plan you're enrolled in and/or the employer group you get your insurance through. The simplest way to check if you have pharmacy benefits is to look at your health plan ID card.
How does my pharmacy benefit work? What will my costs be?
Fallon plans that include pharmacy benefits have a formulary, which is a list of drugs that the plan covers. A formulary is sometimes called a covered drug list. Most of the time, you can’t get coverage for drugs that are not on the list.
How do I find out if a drug is covered?
You can find out if your plan covers a drug by checking the printed covered drug list that you may have received with your plan materials. You can also search for the drug on our online drug formulary.
Where can I get my prescription medications filled?
You can get your prescriptions filled at any pharmacy in your network. You generally won’t be covered for drugs from an out-of-network pharmacy.
More information to understand and use your pharmacy benefit
You can also determine your financial responsibility for a drug, order a refill for an existing unexpired mail-order prescription, find a location of an in-network pharmacy, conduct a pharmacy search based on zip code, determine potential drug-to drug-interactions, determine a drug’s common side effects and significant risks, and determine the availability of generic substitutes online on the OptumRx website..
Questions?
If you need help with your pharmacy benefits or formulary/covered drug list, please call our Customer Service Department at 1-800-868-5200 (TRS 711), Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m.
What is Medicare Advantage?
Medicare Advantage plans are an alternative way to get your Original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans' prescription drug component helps cover medications.
How to contact Medicare for extra help?
To see if you qualify for Extra Help, call: 1-800 -MEDICARE (1-800-633-4227).
How long does Medicare Supplement last?
government or the federal Medicare program. For Medicare Supplement Insurance Only: Open enrollment lasts 6 months and begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B.
How to file a complaint with Medicare?
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days a week or using the medicare.gov site.
Who can contact Medicare Supplement?
Contact may be made by an insurance agent/producer or insurance company. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease.
Do I have to pay Medicare Part B if I have 0 monthly premium?
Even if a plan's monthly premium is $0, you would still pay the Original Medicare Part B premium, and Part A premium if applicable, to have medical coverage. Not all plans shown here will be available to you; enter your ZIP Code to see some of the plans available in your area.
Convenience
Your medications are delivered right to you, saving you trips to the pharmacy and time at the gas pump. Plus, shipping is always free! We even contact your doctor to ask for a 90-day prescription.
Eligible Medications
All medications within tiers 1 through 4 of Wellcare By Fidelis Care's Medicare Drug Formulary are eligible for 90-day supply prescriptions. If you need help finding out if your prescriptions are covered in the Wellcare By Fidelis Care Drug Formulary, please call Member Services at 1-800-247-1447 (TTY: 711).
Additional Information
Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.
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