Get prescription drug information - HMO-POS plans
Subsidy Extra help from Medicare for your drug costs and premiums
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan. This table shows you what your monthly plan premium will be if you get extra help.
|Your level of extra help||Monthly Premium for Spirit Rx||Monthly Premium for Essence Rx||Monthly Premium for Promise Rx||Monthly Premium for Esteem Rx/Assurance Rx/Surety Rx|
Prescription Drug Transition Process
When you first join Security Health Plan, you might be taking a medication that is not on our formulary, or one that is on our formulary, but normally requires prior authorization. Our Prescription Drug Transition Process allows time for you to work with your health care provider to switch to a therapeutically appropriate formulary alternative or to request a formulary exception.
Here’s how it works
At any time within the first 90 days of your enrollment, Security Health Plan will cover a temporary supply when you need a refill of a non-formulary drug, or one that normally requires a prior authorization. The temporary fill will be for up to a 30-day supply (or less, if your prescription is written for less), or for at least a 31-day supply (or less, if your prescription is written for less) if you are a resident in a long-term care facility.
Other times when you will benefit from the Prescription Drug Transition Process
There are times outside of your first 90 days of new membership when the prescription drug transition process will also apply. One of the more common examples would be if you experience a change in your level of care (for example, when you are discharged from a hospital to either your home or to a long term care facility, or if you end your long term care facility stay and return to your home). Security Health Plan will ensure you have an effective transition of care, including your medication therapy, anytime you experience a change in your level of care.
Additionally, for members in a long-term care facility, Security Health Plan will cover at least a 31-day emergency supply of newly prescribed non-formulary medications (or medications which normally require prior authorization) while an exception or prior authorization is requested. This coverage is offered at any time during membership, not just during the first 90 days.
In some situations, current members might also be affected by formulary changes that could occur at the start of a new plan year. If such changes occur, you will be notified at least 60 days in advance. The advance notice will provide sufficient time for you to work with your health care provider to switch to a therapeutically appropriate formulary alternative or to request a formulary exception.
You will be notified
If you are in any of the situations described above, and a temporary supply of medication is dispensed to you, we will send you a letter within three business days notifying you that the supply you received is temporary. The letter will also explain how you and your prescriber can work with Security Health Plan to switch you to an appropriate therapeutic formulary alternative. It will also explain what to do if you want to request a formulary exception in order to continue on your original medication.
Please note that our transition policy applies only to those drugs that are “Part D drugs.” It cannot be used to get coverage for a non-Part D drug. Benefits are only available at network pharmacies except under non-routine circumstances when a network pharmacy cannot be reasonably used. Network pharmacies include designated retail, chain, mail order, long-term care, home infusion and Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) pharmacies. Call Security Health Plan Customer Service for more information.
Security Health Plan and its agents are not in any way connected with the Medicare program. Security Health Plan of Wisconsin, Inc., is an HMO-POS, MSA and D-SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Security Health Plan depends on contract renewal.
This information is not a complete description of benefits. Call Customer Service at 1-877-998-0998 (TTY 711) for more information.
Last updated: October 2018