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Annual prescription drug benefits

Your prescription drug benefit provides drugs covered through Medicare “Part D” plus drugs normally excluded from Part D benefits.

There are no differences among medical benefits between the two Network plan options. Prescription drug benefits, however, differ between the two options.

 

HAP Senior Plus
Henry Ford
Health System
Network Plan

HAP Senior Plus
Expanded
Network Plan

Initial coverage limit*:

$3,000
Annual Part D drug costs paid by you and the plan


Copay for 30-day supply:
$2.00 generic
$15.00 preferred brand
$55.00 non-preferred brand and specialty

Copay for 90-day supply and mail-order:
$5.00 generic
$37.50 preferred brand
$137.50 non-preferred and specialty

$2,830
Annual Part D drug costs paid by you and the plan


Copay for 30-day supply:
$2.00 generic
$35.00 preferred brand
$55.00 non-preferred brand and specialty

Copay for 90-day supply and mail-order:
$5.00 generic
$87.50 preferred brand
$137.50 non-preferred and specialty

“Donut Hole” or
Coverage gap
(Part D and
Covered non-Part D drugs)

Copay for 30-day supply:
$0 generic

Copay for 90-day supply:
$0 generic

HAP negotiated prices on all other drugs

Copay for 30-day supply:
$2.00 generic

Copay for 90-day supply:
$5.00 generic

HAP negotiated prices on all other drugs

Catastrophic coverage:
After you pay $4,550 in annual total out-of-pocket costs (excludes cost of covered non-Part D* drugs, drugs purchased outside the U.S., and premiums if any)

Copay
$2.50 generic
or 5% (whichever is greater)

$6.30 brand and specialty drugs
or 5% (whichever is greater)

*Non-Part D formulary drugs do not count towards the Initial Coverage limit or the calculation of your annual total-out-of-pocket costs to reach the Catastrophic Coverage Period.

Formulary

A list of prescription drugs available to you through the HAP Senior Plus plan. Formulary drugs are dispensed through participating pharmacies.

Your prescription drug benefit provides drugs approved under Medicare “Part D” plus drugs excluded by law from Part D benefits. Two drug lists are provided: Part D and Non-Part D. Together these documents define your covered benefits under the MPSERS' plan.

Non-Part D Formulary drugs do not count towards the Initial Coverage limit or the calculation of your annual total-out-of-pocket costs to reach the Catastrophic Coverage period. This is because even though they are a benefit under your prescription drug coverage, Medicare Part D does not cover them.

Explanation of Benefits

Each month, you receive a statement of activity that shows your Part D prescription drug out-of-pocket cost to date and the remaining benefit amount under your initial coverage limit. Covered non-Part D drugs do not appear on this statement.

Remember, generic drugs are covered at a copay level in the “donut hole,” or coverage gap, with your HAP Senior Plus plan. Receive all other drugs at HAP’s negotiated prices when you show your HAP Senior Plus identification card at a participating pharmacy.

Convenient pharmacies

As a plan member with prescription drug benefits, you may fill your prescriptions at any pharmacy in our network of more than 1,500 pharmacies, which include:

  • Retail (some provide free home delivery)
  • Mail-order (Medco and Walgreens)
  • Network pharmacies associated with long-term care facilities
  • Indian Health, Tribal, and Urban pharmacies

If you travel, you can get your prescription drugs at any network pharmacy with nationwide locations that contracts with HAP (like Walgreens, Kmart, Kroger, CVS, and others).

Generally, you must get your prescription drugs at a pharmacy in our network, except in emergency or urgent care situations.

Call us if you want more information

Your HAP representative can help you with:

  • Full benefit information
  • Network pharmacy information

For pharmacy and mail-order pharmacy information, call Client Services toll-free at (800) 801-1770 or TDD (800) 956-4325.

Our normal office hours are Monday through Friday, 8 a.m. to 8 p.m. and Saturday, 8 a.m. to noon. At all other times, you may access our Interactive Voice Recording system at the same number. We will have extended hours from November 15 through March 1, when Client Services Specialists will be available 7 days a week, including holidays, from 8 a.m. to 8 p.m.

You can also write to us at:
HAP Client Services
Attn: Medicare
2850 West Grand Boulevard
Detroit, Michigan 48202

Getting extra help for prescription drug coverage

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:

  • 800-MEDICARE (800-663-4227), TTY/TDD users should call (877) 486-2048. You can call this number 24 hours a day, 7 days a week, or
  • The Social Security Administration at (800) 772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY/TDD users should call (800) 325-0778 or
  • Your state Medicaid office

Learn more about getting extra help

Important information

Generally, your Medicare Advantage plan outpatient prescription drug benefits are only available at contracted network pharmacies, except in emergency or urgent care situations. Medicare Advantage plan members must receive prescription drug coverage through their plan. If you enroll in a stand-alone Prescription Drug Plan (PDP), you will be disenrolled from your Medicare Advantage plan.

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