EXPRESS SCRIPTS MEDICARE RETIREE PRESCRIPTION PLAN
Open Enrollment is October 12 - 23, 2015
for Highmark Delaware Special Medicfill and
Express Scripts Medicare (PDP) for the State of Delaware*
Plan Year January 1 - December 31, 2016
*Special Medicfill is the State of Delaware Medicare Supplement Plan. Express Scripts Medicare (PDP) is the State of Delaware Medicare Prescription Plan.
- If you have Medicare plus the State's supplement and prescription plan and want to keep it, you do not need to do anything unless your spouse's employment status or coverage has changed.
- Do you cover a spouse? Complete a new Spousal Coordination of Benefits Form only if your spouse's employment status or coverage has changed since you last completed this form.
- Take action if:
- You are enrolled in Special Medicfill without prescription coverage and wish to enroll now in the State's Medicare Retiree prescription plan, Express Scripts Medicare (PDP) for the State of Delaware, for an effective date of January 1, 2016.
- You are eligible for, but not enrolled in, Special Medicfill now. You may enroll now for an effective date of January 1, 2016. You may select Special Medicfill with prescription coverage or Special Medicfill without prescription coverage.
- You want to drop prescription coverage or Special Medicfill with prescription coverage.
- Important Notes
- Coverage through another Medicare Part D prescription drug plan is not allowed if you wish to keep your prescription coverage through Express Scripts. If you enroll in another Medicare prescription drug plan, prescription drug coverage through the State of Delaware for you will terminate.
- Retirees and/or their dependents must enroll in Medicare A and B when eligible due to age or disability, and a signed copy of the Medicare card must be submitted to the Office of Pensions or to the non-State participating group's benefits office prior to enrollment in the Highmark Delaware Special Medicfill with Prescription Coverage Plan.
- When your enrollment is submitted for Express Scripts Medicare prescription coverage, you will first receive a pre-notification letter from Express Scripts, and you will receive new identification cards in the Welcome Kit a few weeks later.
- Special Medicfill Rates Beginning January 1, 2016:
The actual premium you pay will be determined by the amount or percentage paid by the State.
Rates effective through December 31, 2015
Cost Savings With 90-Day Prescriptions: You'll pay only 2 times your 30-day retail co-payment if you order up to a 90-day supply of covered medication at a 90-day participating pharmacy or through Express Scripts mail order service.
Rates effective through January 1, 2016
Effective January 1, 2016, erectile dysfunction medications will not be covered unless medically necessary for a condition other than erectile dysfunction. Coverage of erectile dysfunction medications for medical necessity requires coverage review.
Additional information on the coverage review process is forthcoming. Erectile Dysfunction medications can be obtained at the pharmacy with a prescription for a discounted price.
- List of Covered Drugs (Formulary)
- DIRECT CLAIM FORM FOR EXPRESS SCRIPTS MEDICARE - You may print copies of this form for use when a pharmacy requires that you pay out of pocket for a prescription for one of the following reasons:
- The pharmacy is a non-participating pharmacy.
- You have other coverage that is primary, and this is a coordination of benefits claim.