Prescription Coverage

Commonwealth Care Alliance is a Medicare contractor offering a prescription drug benefit. As an enrolled member, you have no out-of-pocket expense for your prescription drug coverage. Our comprehensive drug formulary lists drugs we cover. We will cover the drugs listed in the formulary as long as they are medically necessary. The drugs on the formulary are selected with the help of a team of healthcare providers. Your enrollment entitles you to coverage of those drugs that you would normally receive under Medicare Parts A and B. Our SCO and CCC programs also cover some additional vaccines and drugs that are not normally covered by Medicare Part B.

You will receive an Explanation of Benefits every month. The Explanation of Benefits will contain information about the prescription drugs that you get from our programs; the amount of money that our programs pay for your drugs; information about how to request an exception and how to appeal our coverage decisions; and a description of changes that will occur to the drug formulary at least 60 days in the future.

If you are admitted to a hospital, we will provide your prescription drugs under your medical benefit. When you are released from hospital, we will provide your prescription drugs under your outpatient drug benefit. Drugs on our formulary are organized into different drug “tiers”, or groups of different drug types. 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 rated by the Food and Drug Administration (FDA) to be safe and as effective as brand name drugs.

Last updated 09/03/2008