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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
