Members

Part D Prescription Drug Coverage

The iCare Medicare Plan’s all-in-one benefits include the Medicare Part D Prescription Drug program, meaning you do not need to look for a separate program to fulfill your prescription drug needs. Our Medicare Part D Prescription Drug benefit is only available to members of the iCare Medicare Plan. If you are already enrolled in a Medicare Advantage Prescription Drug Plan, you must receive your Medicare Prescription Drug benefit through that plan until your iCare Medicare Plan coverage begins.

What is the Cost to Fill My Prescriptions?

• Generic Prescription Drugs - $0 co-pay
• Brand-Name Prescription Drugs - $3.20 or $6.00 co-pay (depending on your income level)

After $2,700 annual limit

• Generic Prescription Drugs - $1.10 or $2.40 (depending on your income level)
• Brand-Name Prescription Drugs - $3.20 or $6.00 (depending on your income level)

After $4,350

• Generic Prescription Drugs - $0
• Brand-Name Prescription Drugs - $0

Extra Help (Low Income Subsidy)

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours-a-day/7days-a-week); the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday, TTY/TDD users should call, 1-800-325-0778; or your State Medicaid Office.

What if you believe you have qualified for extra help and you believe that you are paying an incorrect co-payment amount?

If you believe you have qualified for extra help and you believe that you are paying an incorrect co-payment amount when you get your prescription at a pharmacy, our Plan has established a process that will allow you to either request assistance in obtaining evidence of your proper co-payment level, or, if you already have the evidence, to provide this evidence to us. Independent Care Health Plan follows CMS’ Best Available Evidence policy (BAE). Please contact Member Services at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 am to 8:00 pm, for assistance with obtaining evidence of your proper co-payment level or for more information on providing this information to us. When we receive the evidence showing your co-payment level, we will update our system or implement other procedures so that you can pay the correct co-payment when you get your next prescription at the pharmacy. Please be assured that if you overpay your co-payment, we will reimburse you. Either we will forward a check to you in the amount of your overpayment or we will offset future co-payments. Of course, if the pharmacy hasn’t collected a co-payment from you and is carrying your co-payment as a debt owed by you, we may make the payment directly to the pharmacy. If a state paid on your behalf, we may make payment directly to the state. Please contact Member Services if you have questions.

Are My Medications Covered?

The iCare Medicare Plan covers thousands of prescription drugs. Click on the Comprehensive Formulary link on the right under the PDF Resources to find out what drugs are covered in our formulary, or call Member Services at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.

Where Can I Get My Prescriptions Filled?

Members must use network pharmacies to obtain their prescription drugs, except under non-routine cases when you cannot make it to a network pharmacy. A network pharmacy is a pharmacy that has contracted with the iCare Medicare Plan, where beneficiaries access prescription drug benefits provided by the iCare Medicare Plan. In most cases, your prescriptions are covered under the iCare Medicare Plan only if they are filled at a network pharmacy. We have contracted with over 1,000 retail pharmacies throughout the State of Wisconsin, which equals or exceeds the Centers for Medicare and Medicaid (CMS) requirements for pharmacy access in your area. Click on the Pharmacy Listing link on the right under the PDF Resources to to see what pharmacies are in our network.

Every year as long as you are a member of the iCare Medicare Plan, we will send you a Provider Directory, which provides you with a listing of network pharmacies. You can use it to find a network pharmacy near you.

Filling Prescriptions Outside the Network

We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. Generally, we only cover drugs filled at an out-of-network pharmacy in limited circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out-of-network pharmacy. Before you fill your prescription in these situations, call Member Services to see if there is a network pharmacy in your area where you can fill your prescription. If you go to an out-of-network pharmacy for the reasons listed below, you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy so that any amount you pay will help you qualify for catastrophic coverage.

We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:

• If you are traveling within the United States and territories and become ill, lose or run out of your prescription drugs.
• If the prescriptions are related to care for a medical emergency or urgent care.
• If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24 hour service.
• If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (including high cost and unique drugs).
• If you are getting a vaccine that is medically necessary but not covered by Medicare Part B and some covered drugs that are administered in your doctor's office.

We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency.

How Do I Submit a Paper Claim?

When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy for one of the reasons listed above, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. When you return home, simply submit your claim and your receipt to the following address:

Upon receipt, we will make an initial coverage determination on the claim.

Plan Transition Process

Click here to see our plan transition process. This will tell you how iCare will help if your present prescription drug is not on the iCare Medicare formulary or it is taken off of the iCare formulary after you become a member.

Contact Us

Questions? Call us at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.

Medicare

• Benefits and Services
• How Do I Enroll?
• Part D Prescription Drug Coverage
• Prescription Drug Information and Formulary
• Grievance Policy
• Exception and Appeals Policy
• Coverage Limitation