Enhanced Prescription Drug Benefits:

All Capital Health Plan Medicare Advantage (HMO) plans will offer a 90-day retail supply and a 90-day mail order supply of most prescriptions beginning January 2012.

To take advantage of the 90-day retail supply just ask your physician’s office for a 90-day prescription and fill the prescription at your local pharmacy.

To take advantage of the 90-day mail order service:

Contact your physician’s office and ask for a 90-day prescription with three refills. 

• Fill out the Mail Service Order Form. 
  • Download the form at caremark.com under “Forms for Print.” 
  • Or, call Member Services at the numbers listed below, and we will mail you a form. 
• Mail the form to Caremark at the address printed on the form.

Drugs available through mail order are drugs you take on a regular basis, for a chronic or long term medical conditions.  The drugs that are not available through mail order service are marked with a “NM” (not available at mail order) on your Formulary (drug list).   The Formulary is available on line at capitalhealth.com/2012 Medicare. All Medicare Advantage members enrolled in plans that renew between October 1 and January 1 have also received the new 2012 Formulary by mail.  

Medicare-Covered Preventive Services:  

Most preventive services have been covered by Capital Health Plan at no cost to members in the past.  However, in 2012 members will see some additional preventive services covered at no cost.  Please refer to your Evidence of Coverage, Chapter 4, for a list of preventive services.   This is a good time to check and make sure you have completed your annual screenings for 2011.

For other 2012 changes, please refer to your Annual Notices of Changes and Evidence of Coverage.

Questions:  Contact Member Services, 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. to 8:00 p.m., seven days a week.

H5938_DP 267 File & Use 11222011

Karen Frost, RN, BSA, MBA

Director of Member Services

Capital Health Plan strives to provide our members with outstanding customer service. This section of the HealthLINE answers general coverage or procedural questions that we receive on a regular basis.

Question: How can I find the cost of my prescription drugs?

Answer: Prescription drugs are separated into different levels of costs called tiers - the lower the tier, the lower the cost to you. Depending on your plan, your prescriptions may be divided into 3 or 4 tiers. To find the copayments or coinsurance you will pay for each tier, and the tier for each prescription drug, follow these steps:

Non-Medicare Members:

1.) First find the tiers and associated copayments for your plan on the front of your member ID card.

2.) Then find the tier for each of your prescriptions. Visit capitalhealth.com:

• On the CHP homepage, under “Popular Links and Documents,” click “Prescription Drug Benefit.”
• Download a copy of the Complete Formulary (for 3 Tier plans only) as well as the Preferred Medication List and locate your prescriptions. Match the tier listed for each drug to the appropriate copayment for your plan to find what you will pay.

Medicare Members:

1.) First find the copayment or coinsurance for each prescription drug tier for your plan. Visit capitalhealth.com:

• Click on the tab labeled “Medicare.”
• Then, choose the colored box with the plan you are enrolled in.
• For CHP Advantage Plus (HMO) and CHP Preferred Advantage (HMO) members, the chart in the middle of the page will tell you the copayments or coinsurance for each drug tier. CHP Retiree Advantage (HMO) members should consult the copayment schedule included with your 2011 Annual Notice of Changes and Evidence of Coverage.

2.) Next find the tier for each of your prescription drugs. Stay on the plan-specific web page at capitalhealth.com:

• In the left column, click “Prescription Drug Coverage”.
• Then click “Formulary (Drug List).” On this page you can download a copy of the CHP Medicare Advantage Formulary for your plan. CHP Advantage Plus and CHP Preferred Advantage members can also use the “Formulary Search Tool.” These tools tell you the tier for each prescription drug. Match the tier listed to the copayment or coinsurance for that tier to find what you will pay.

3.) CHP Advantage Plus and CHP Preferred Advantage are subject to the gap in coverage. The copayments or coinsurance for CHP Advantage Plus do not apply if you reach the gap in coverage ($2840 each year). The copayments for CHP Preferred Advantage only apply to Tier 1 generic drugs if you reach the gap in coverage.

Another important resource for Capital Health Plan members is caremark.com.

Capital Health Plan works with CVS Caremark to administer your pharmacy benefits. The Caremark website (www.caremark.com) provides specific information about your medications including refill history and cost, general information on medications (side effects, storage concerns, and drug interactions), and the benefit of using generics over brand name medications. Visit caremark.com and register for a free account today.

If you have trouble logging in to Caremark’s website, or you do not have access to a computer, contact their customer service department at 1-800-966-5772.

If you have trouble with these resources or do not have access to the internet, contact your local Member Services Representatives.

Member Services

Five days a week 8 a.m. – 5 p.m.

850.383.3311 or 800.390.1434

Medicare Member Services:

Seven days a week 8 a.m.– 8 p.m.

850.523.7441 or 877.247.6512

TTY/ TTD: 850.383.3534 or 800.955.8771

Have you been taking certain medications over a long period of time?

Your doctor may want you to have specific tests from time to time depending on the type of medication you take. These simple blood tests will tell your doctor if you are experiencing any unwanted side effects and confirm that you have the correct amount of the medication in your bloodstream. Regular monitoring may be recommended if you are taking any of the follow drugs:

As you get older, the way your body processes medication changes. As a part of the normal aging process, your body will most likely have a higher proportion of fat to muscle and a natural decline in kidney function. This makes it harder to clear drugs from your system. You may also be more sensitive to certain drugs.

These changes could put you at risk for serious side effects such as confusion, depression, falling, or other health consequences. A group of medical experts developed a list of drugs that are potentially inappropriate for patients aged 65 or older. This list is called the Beer’s Criteria, and some of the drugs are shown below, along with concerns and possible alternatives to these drugs.

Since the risks associated with these medications may outweigh the benefits, talk with your doctor if you are taking any of the drugs listed in the first column and ask if any of the alternatives would be appropriate for you. However, do not stop taking any prescribed medications without first consulting your doctor.

Did you know that our bodies begin to respond differently to medications as we get older?

As we age, various changes occur throughout the body. For example, the liver or kidneys may not clear a medication from our system as efficiently as it once did. Likewise, receptors in the body may become more sensitive to certain drugs. These changes have the potential to make us more susceptible to serious and unwanted effects, such as: confusion, depression, falling, and other health consequences. A group of medical experts developed a list of drugs potentially inappropriate for patients aged 65 or older. This list is called the Beer’s Criteria. Some of the drugs are shown below, along with concerns and possible alternatives to these drugs.

Because the risks associated with these medications may outweigh the benefits, talk with your physician about some of the possible alternatives. However, do not stop taking them without first consulting with your doctor.

Sounds obvious, doesn’t it? Not to everyone. According to the World Health Organization, almost half of Americans who are prescribed high blood pressure medication do not take it consistently. That equals very risky business—risky for debilitating strokes. Skipping or stopping medicine is an issue in many chronic or serious illnesses that require long-term, daily medication.

Taking medication consistently—sometimes different pills several times a day—can be confusing or hard to remember, but it’s important: medicine cannot work if you don’t take it. Without it, your symptoms will return or worsen, an emergency may result (perhaps irreversible), and you’ll spend more time and money under care. Here are some tips.

1. Get facts: Know exactly at what times and in what dosages to take the medicine, as well as special instructions (such as taking with food) and possible side effects. If you’re unclear, ask your physician or pharmacist.

2. Report all medications: List and report all medications you are taking to every physician and to your pharmacist. This is very important to prevent adverse drug interactions.

3. Organize in advance: Put your pills for the next day or week into a compartmented pill box. Many styles exist, some marked for time of day. You’ll know at a glance what you need to take and whether you have.

4. Remind yourself. Put the pill box where you can’t miss it, for example, by your toothbrush for a morning routine. Or put notes to yourself in obvious places: on the refrigerator, a mirror, or your telephone at work. Some people use a calendar or notebook to keep track of all medications.

5. Refill on time. Make a note to refill a prescription a week before it will run out.