Members

Members on HMO-POS and PPO plans can check multiple medications and estimate annual drug costs by using our Find & Price Prescription Drugs tool. The tool is not applicable for those on the Dual Plus (HMO-POS D-SNP) plan because of differences in cost share for those plans.

We will send you an Explanation of Benefits (EOB) for each month when you use your benefits or if we need to notify you of a change in coverage for a drug you are currently taking.

Your EOB will include how much you have paid so far this year for your prescriptions as well as any recent claims. Please Note: Items/services appear on the EOB when a claim is processed, not necessarily for the month in which you received the item or service.

Want to go paperless? By registering with Express Scripts, you have the option to receive your Part D EOB statements online rather than by mail.

You can also:

1. Get up to 18 months of EOB statements. Your Medicare Part D EOBs are stored securely online, so you can view, print or download them whenever you need them.
2. Quickly view summaries of drug claims processed since your last EOB and see your total out-of-pocket and drug costs.
3. Easily find information about your benefit stage, including how close you are to the Coverage Gap.
4. View any updates to the list of covered drugs that could affect your medications.

Under certain circumstances, you may be able to get a temporary supply of a drug when your drug is not on the Drug List or when it is restricted in some way. This gives you time to talk with your provider about your options. To be eligible for a temporary supply, you must meet the two requirements below:

1. The change to your drug coverage must be ONE of the following types of changes:
• The drug you have been taking is no longer in the formulary
• The drug you have been taking is now restricted in some way
2. You must be in ONE of the situations described below:
• Members who are new or who were in the plan last year and aren’t in a long-term care (LTC) facility: We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you were new and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of a 30-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy.
• Members who are new or who were in the plan last year and reside in a long-term care (LTC) facility: We will cover a temporary supply of your drug during the first 90 days of your membership in the plan if you are new and during the first 90 days of the calendar year if you were in the plan last year. The total supply will be for a maximum of a 98-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 98-day supply of medication. The long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.
• Members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away: We will cover one 31-day supply of a particular drug, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.
• Members who are enrolled in a Dual Plus (D-SNP) plan and are new to the plan or who were in the plan last year: For D-SNP members, we will cover a temporary supply of your drug during the first 120 days of your membership in the plan if you were new and during the first 90 days of the calendar year if you were in the plan last year. This temporary supply will be for a maximum of a 30-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of a 30-day supply of medication. The prescription must be filled at a network pharmacy.

Do you need help understanding the difference between your deductible and copay? Or generic drugs and tiers? Use this list of common terms to help you understand your coverage and benefits.

People with limited incomes may qualify for "Extra Help" to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, copays and/or coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. For more information about this "Extra Help," contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To find out more about Medicaid and its programs, contact:

Louisiana Department of Health

P.O. Box 629

Baton Rouge, LA. 70821-0629

Phone:

1-888-342-6207

ldh.la.gov/subhome/1