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1. What are Medcore prescription drugs options? 2. What is a formulary? 3. Does my plan have a prescription drug Formulary? 4. What type of drugs may be covered under Medicare Part B? 5. What it the difference between brand name and generic drugs? 6. What is quantity limits for prescription drugs? 7. What is a medication therapy management (MTM) program? 8. What are generic drugs? 9. What is step therapy? 10. Define prior authorization. 11. How do I request an exception to the Medcore Formulary? 12. Are long-term care pharmacies apart of Medcore pharmacy network? 13. Are home infusion pharmacies apart of Medcore pharmacy network? Filling Prescriptions 14. Where can I get my prescriptions filled? 15. What pharmacies are in the Express Scripts network? 16. Filling prescriptions at a non-network pharmacy. 17. Network pharmacies outside San Joaquin County Mail Order Prescriptions 18. How do I fill a prescription through Medcore's mail-order pharmacy? 19. Is there a charge for shipping? 20. How much will I save by using mail order? 21. How long does it take to receive prescriptions through mail order? 22. Where is the Express Scripts Mail Order Pharmacy located? 23. Will information that I submit through any of the Express Scripts Internet sites be secure and confidential? 24. What are the hours of operation for Express Scripts Call Center? What are Medcore Prescription Drugs options?Medcore HP provides two plan options with Medicare Part D Prescription Drug coverage. The two options include Medcore Gold and Medcore Gold-Select (Medicare & Medi-Cal). Both of these plans are Medicare Advantage Part D Prescription Drug plans.Medcore HP also has a plan option, Medcore Silver, for people with Medicare who already have creditable drug coverage from another source, or who do not wish to select Part D coverage. Medcore Silver is a Medicare Advantage plan that includes all of the medical benefits covered in Medcore Gold, however does not include Medicare Part D Prescription drug coverage. Medcore Gold and Medcore Gold Select use a prescription drug formulary, which is a preferred list of drugs selected to meet patient needs. The plans may make periodic changes to the formulary. If the formulary changes, affected enrollees will be notified, in writing, before the change is made. Contact Medcore HP for further details. To review the Comprehensive Formulary for Medcore Gold and Medcore Gold Select, click on the Comprehensive Formulary selection. The Comprehensive Formulary lists most of the drugs included in the formulary and also includes information on additional programs, such as Medication Therapy Management, and how to request an exception if your drug is not included in the formulary. Top Where can I get my prescriptions filled?Medcore Gold and Medcore Gold Select members may obtain their prescriptions at any of the local retail pharmacies or by mail order. Please see the Pharmacy Directory for Medcore Gold and Medcore Gold-Select for a list of Medcore HP's network pharmacies. The directories are for San Joaquin County.Pharmacies may have been added or removed from the list after this directory was printed. To get current information about Medcore HP network pharmacies in your area, please call our Customer Service Department at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm (TTY/TDD Users should call 1-800-258-6810). For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688. We call the pharmacies listed in the Pharmacy Directory our "network pharmacies" because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Medcore. In most cases, your prescriptions are covered under Medcore only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one, you are not required to continue going to the same pharmacy to fill your prescription, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described later. Pharmacies are listed in the directory in alphabetical order and by zip codes in the San Joaquin County. If you have any questions about our network pharmacies or about Medicare in general, please call us at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm (TTY/TDD Users should call 1-800-258-6810). For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688. Top What Types Of Drugs May Be Covered Under Medicare Part B?The following outpatient prescription drugs may be covered under Medicare Part B. This may include, but is not limited to, the following types of drugs. Contact Medcore Gold for more details.
Top What Is A Medication Therapy Management (MTM) Program?A medication therapy management (MTM) program is a benefit that your plan may offer. You may be identified to participate in a program designed for your specific health and pharmacy needs. It is recommended that you take full advantage of this covered benefit if you are selected. Contact Medcore Gold for more details.Top What are generic drugs?Medcore Gold and Medcore Gold Select cover both brand-name drugs and generic drugs. A generic drug has the same active-ingredient formula as the brand name drug. Generic drugs usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA).Ask your physician if you are taking a brand name drug and want to know if there is a generic version, or contact our Customer Service Department at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm (TTY/TDD Users should call 1-800-258-6810). For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688. Top What is Step Therapy?Some covered drugs may have additional requirements or limits on coverage. These requirements may include Step Therapy. In some cases, Medcore Gold and Medcore Gold Select require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Medcore Gold may not cover drug B unless you try Drug A first. If Drug A does not work for you, Medcore Gold will then cover Drug B.You can find out if your drug has any additional requirements or limits by looking in the formulary. Click on the "Comprehensive Formulary" selection. Top What is Quantity Limits for prescription drugs?Some covered drugs may have additional requirements or limits on coverage. These requirements may include Quantity Limits. For certain drugs, Medcore Gold and Medcore Gold Select limit's the amount of the drug that Medcore Gold will cover. For example, Medcore Gold provides 5 tablets per prescription for Fosamax 70 mg. This may be in addition to a standard 30- or 90-day supply.You can find out if your drug has any additional requirements or limits by looking in the formulary. Click on the "Comprehensive Formulary" selection. Top Define Prior Authorization.Some covered drugs may have additional requirements or limits on coverage. These requirements may include Prior Authorization. Medcore Gold and Medcore Gold Select require you to get prior authorization for certain drugs. (You may need prior authorization for drug that are on the formulary or drugs that are not on the formulary and were approved for coverage through our exceptions process.) This means that you will need to get approval from Medcore HP before you fill your prescriptions. If you don't get approval, Medcore HP may not cover the drug.You can find out if your drug has any additional requirements or limits by looking in the formulary. Click on the "Comprehensive Formulary" selection. Top Network Pharmacies Outside San Joaquin CountyIf you are going to be out of the area for an extended length of time, or have an urgent need for a prescription while you are out of the service area, you may access one of Express Scripts 50,000 pharmacies throughout the United States. As a Medcore Gold or Medcore Gold Select plan member you will receive the same prescription drug coverage available to you at one of the local contracted pharmacies.Top How do I request an exception to the Medcore Gold's Formulary?You can ask Medcore Gold or Medcore Gold Select to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.
You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of your request. Top How do I fill a prescription through Medcore HP's mail order pharmacy service?Medcore can provide a mail order form to have your maintenance medications and prescriptions delivered right to your home. To receive and order forms and additional information about filling your prescriptions by mail please call our Customer Services at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm. (TTY/TDD Users should call 1-800-258-6810), or click on the "Mail Order Form" selection. Please note that you must use the Medcore mail order service. Prescription drugs that you get through any other mail order service are not covered. You can use the mail order service to fill prescriptions for what we call "mail order drugs" / "maintenance drugs". These are drugs that you take on a regular basis, for a chronic or long-term medical condition. The formulary list tells you which drugs we consider to be mail order / maintenance drugs. These are the only drugs available through our mail order service.When you order prescription drugs by mail, you must order at least a 60-day supply, and no more than a 90-day supply of the drug. You are not required to use mail order prescription drug services to obtain an extended supply of maintenance medications. Instead, you have the option of using a preferred or non-preferred retail pharmacy in Medcore's network to obtain a maintenance supply of medications. Some retail pharmacies may agree to accept the mail order reimbursement rate for an extended supply of medications, which may result in no out-of-pocket payment difference to you. Top Filling prescriptions at a non-network pharmacyPlease review the Pharmacy Directory "Filing prescriptions at a non-network pharmacy" for information about exceptions when we will pay for a prescription filed at a pharmacy outside of our network.If you plan to travel, you can call Member Services at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm. (TTY/TDD Users should call 1-800-258-6810) to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, Customer Service may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy. For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688. We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency. Top Does My Plan Have A Prescription Drug Formulary?Medcore Gold and Medcore Gold Select both use a formulary. A formulary is a preferred list of drugs selected to meet patient needs. The plan may periodically make changes to the formulary. If the formulary changes, affected enrollees will be notified, in writing, before the change is made. Call our Customer Service Department at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm. (TTY/TDD Users should call 1-800-258-6810) for details. For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688.Top Are long-term care pharmacies a part of Medcore pharmacy network?In some cases, residents of a long-term care facility may access their prescription drugs through their long-term care pharmacy. Please call our Member Services Department at 1-800-320-5688, Monday - Friday, 8:00 am - 5:00 pm (TTY/TDD Users should call 1-800-258-6810). For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688.Top Are home infusion pharmacies apart of Medcore pharmacy network?Medcore will cover home infusion therapy if:
Top What is a formulary?A formulary is a list of preferred medications that are safe, clinically effective, and economical. It is created, reviewed and updated by an independent committee of physicians and pharmacists. The formulary contains a wide range of generic and brand name preferred products that have been approved by the Food and Drug Administration (FDA). Your doctor can use this list to select medications for your health care needs, while helping you maximize your prescription drug benefit. Medications on the formulary may be purchased from contracted local retail pharmacies or through Express Scripts mail order.Top What it the difference between brand name and generic drugs?A drug's brand name is the name under which the product is advertised and sold. This name is protected by a patent so that only one manufacturer can produce it for the duration of the patent. Once the patent expires, other manufacturers may produce a "generic" that is chemically equivalent to the brand name drug and follows stringent FDA regulations for safety.A generic drug is a drug whose patent has expired. Other manufacturers can produce and distribute the product under the generic name that is different than the original brand name. A generic is essentially a chemical copy of their brand name drug. The color and shape may be different, but the active ingredients must be the same. The formulary contains only FDA- approved generic medications. An example of a generic medication is diazepam, which is the generic equivalent of Valium. Top What pharmacies are in the Express Scripts network?The Express Scripts network includes major chains as well as independent pharmacies. You can get information about specific pharmacies by logging onto the Express Scripts web site at www.express-scripts.com.Top What are the hours of operation for Express Scripts Call Center?Medcore Gold and Medcore Gold-Select members have a dedicated toll-free number to call for inquiries about the prescription drug program. The number is listed on your Prescription Drug Card. This number will be answered by an Express Scripts Call Center Associate 24 hours a day, seven days a week. If you need to speak with a registered pharmacist, one will always be available through the Express Scripts Call Center.Top Where is the Express Scripts Mail Order Pharmacy located?Your mail order prescriptions will be filled form the Express Scripts Mail Order facility located in Arizona.Top Is there a charge for shipping?No. There is no charge for shipping.Top How much will I save by using mail order?If you use the mail order service you receive three months supply for the price of two for each prescription ordered.Top How long does it take to receive prescriptions through mail order?From the date you mail your prescription order to the day your prescription reaches your home, is usually between 10 to 14 days. Refills can be ordered by 1 of 3 methods: 1) Express Scripts Call Center Interactive Voice Response system, 2) Speaking to an Express Scripts Call Center Associate, 3) Express Scripts Web-site, www.express-scripts.com. Refills are usually delivered within 7 to 10 days. For questions related to the Medicare Part D Prescription Drug program, Member Services representatives are available to respond to your prescription drug questions 8am to 8pm, seven days a week by calling 1-800-320-5688.Top Will information that I submit through any of the Express Scripts Internet sites be secure and confidential?Yes. Your information is confidential. Express Scripts has strict policies about using confidential information provided by our members.Top |
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