PRESCRIPTIONS

Plan Administrator – Medco

• Medco Website
  
  Member Services 1-800-939-2142
  Available 24 hours a day, 7 days a week, 363 days a year
  (Closed Thanksgiving and Christmas Days)
   
• Women’s Health Center

Prescription Copays

	Rates effective July 1, 2006
	STATE OF DELAWARE PRESCRIPTION COVERAGE TIER 1 GENERIC TIER 2 PREFERRED (FORMULARY) TIER 3 NON-PREFERRED (NON-FORMULARY) 30-DAY SUPPLY $8.50 $20.00 $45.00 90-DAY SUPPLY $17.00 $40.00 $90.00

Maintenance Medication Program Effective 7-1-09

• Information on Maintenance Medication Program
• Quick Reference Guide of Savings
• Announcement Letter to Members – June 1, 2009
• Reminder Letter to Members after July 1, 2009
• Examples of Maintenance Medications – Call Medco’s Member Services at 1-800-939-2142 to learn of others

Pharmacies

• Letter recommending 90-day prescription fills 12-12-08
• How 90-day prescriptions can save you costs
• 90-Day Participating Pharmacies in Delaware
• 90-Day Participating Pharmacies Nationwide
• NON 90-Day Participating Pharmacies in Delaware (these pharmacies CANNOT provide 90-day prescriptions with cost savings for State of Delaware members)

Formulary

• Formulary of Preferred Prescriptions Effective January 1, 2010
• Link to complete preferred formulary

Documentation and Forms

• Coverage Review Process – 10-2006
• FAQ
• Picture of Identification Card
• Welcome Kit
  
  • Letter of Introduction
  • Your Pharmacy Benefit Program Handbook
  • Identification Cards --- MUST be used to obtain prescription at retail pharmacy
  • Medco by Mail Order form to request refills or have new prescriptions filled
  • Coordination of Benefits/Direct Claim form to request secondary coverage or request reimbursement
  • Prescription Fax form to submit prescriptions by fax, use fax number on form
  • Health, Allergy & Medication Questionnaire form for each participant (not available to place on site at this time)
    (some families may receive in a separate mailing). Please contact Member Services to receive replacement or additional copies.

Step Therapy Program

• Information on the Step Therapy Program

Diabetic Program

• Effective 7-1-08 diabetic supplies (lancets, test strips, syringes/needles) provided via Medco, either at a participating retail pharmacy, a 90-day participating retail pharmacy, or Medco-by-Mail may be obtained at no cost. Diabetic medications provided via Medco at a 90-day participating retail pharmacy or Medco-by-Mail and purchased at the same time may be obtained for one co-pay. Diabetic medications are considered to be maintenance medications and must be filled in conformance with the Maintenance Medication Program. Maintenance medications must be filled as 90-day prescriptions after receiving three 30-day prescription or a 30-day prescription will be provided with a 90-day co-pay, additional information is listed above at Maintenance Medication Program.
   
  • Supplies listed by category and drug name
  • Supplies listed in alphabetic order
  • Supplies listed by category and National Drug Code (NDC)
  • Supplies listed by name and National Drug Code (NDC)
    

• Medicare Part B
  Some medications and diabetic supplies are covered through Medicare Part B for those enrolled in Medicare Part B.  Prescriptions for these medications and diabetic supplies will first be processed through Medicare Part B, and pay at 80%, with the member responsible for the remaining 20% at the time of purchase.  Reimbursement of the 20% may be obtained by submitting a Coordination of Benefits/Direct Claim Form, with receipts, to Medco. 

  Medco’s Coordination of Benefits/Direct Claim Form may be found at the following website or requested by calling Medco’s Customer Services at 1-800-939-2142. The completed form with receipts should be mailed to the address provided on the form.
  http://ben.omb.delaware.gov/script/documents/medco/Co_of_Ben_Direct_Claim_Form.pdf

  Questions about specific medications and diabetic supplies covered through Medicare Part B may be answered by calling Medco’s Member Services at 1-800-939-2142.

• Effective 7-1-06

Drug Recall

• Digitek (Digoxin) Recall
  
  • Actavis recalls all lots of heart drugs Bertek and Digitek (PDF)
  • Actavis initiated a class 1 recall of Digitek (digoxin) all strengths for oral use (DOC)
  
  
• Raptiva - Voluntary Recall by Genentech

Medicare Part B
Some medications and diabetic supplies are covered through Medicare Part B for those enrolled in Medicare Part B.  Prescriptions for these medications and diabetic supplies will first be processed through Medicare Part B, and pay at 80%, with the member responsible for the remaining 20% at the time of purchase.  Reimbursement of the 20% may be obtained by submitting a Coordination of Benefits/Direct Claim Form, with receipts, to Medco. 

Medco’s Coordination of Benefits/Direct Claim Form may be found at the following website or requested by calling Medco’s Customer Services at 1-800-939-2142. The completed form with receipts should be mailed to the address provided on the form.
http://ben.omb.delaware.gov/script/documents/medco/Co_of_Ben_Direct_Claim_Form.pdf

Questions about specific medications and diabetic supplies covered through Medicare Part B may be answered by calling Medco’s Member Services at 1-800-939-2142.

Medicare Part D

• Frequently Asked Questions (FAQ) About Creditable Coverage and Medicare Part D: What do they mean to you?
• Notice of Creditable Coverage

 

Last Updated: Monday February 01 2010