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Clinical Review Criteria Clinical Review Criteria are available here Useful Websites American Academy of Pediatrics National Heart, Lung, and Blood Institute United States Preventive Services Task Force UpToDate Alcohol and ...
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Last Updated: 02/05/2025
in Medicare Your health plan is here for you. Visit this site to learn about what to do in a disaster or emergency.
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Last Updated: 12/11/2024
in Medicare Your Pharmacy Info Better therapeutic outcomes for members with multiple conditions Our Medication Therapy Management Program (MTMP) is focused on improving therapeutic outcomes for Medicare Part D members. To qualify for MTMP, a member must meet all of the following...
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Save Money in Our Network Our network is a group of doctors, hospitals, pharmacies, and other health care providers who have agreed to provide services to our members. Because of this agreement, we know how much services from them will cost, so y...
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EGWP’s or Employer Group Waiver Plans are Medicare Advantage plans offered by employers or unions to their retirees. The plans are provided and managed by private insurance companies. These plans are exempt from certain rules that apply to individ...
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If you're having trouble affording your medicine, contact your doctor, your case manager, or our pharmacy department at (800) 851-3379, option 4 to discuss your options and support. For Group Medicare Members: If you experience hardship from hig...
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Additional Terms and Definitions A Accreditation Shows that a health plan meets standards set by an official review committee or organization. Acute Care Short-term care for an illness or health problem. Adjudication The process of paying ...
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Each Medicare Advantage plan with prescription drug coverage or Part D plan has its own list of covered drugs, called a formulary. Our pharmacy department partners with physicians from other health systems who are specialized in their field to dec...
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Last Updated: 10/01/2024
in Medicare Your Pharmacy Info A biosimilar is a highly similar product to the original biologic medication already approved by the Food and Drug Administration (FDA). Biosimilars are made with the same types of natural products and administered in similar ways. Biosimilars have ...
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For a Medicare Part D plan, you'll pay: A set monthly premium. A Part D deductible (if applicable). Copayments or coinsurance for your drug costs. All your other Medicare or Medicare Supplement costs. Medicare Part C plans may include Medicare...