Drug Benefits Information
View and or search the 2013 Formulary (effective January 1, 2013)
2013 MAPD Comprehensive Formulary (Complete list of covered drugs)
Note: Brand name drugs listed in parentheses within the MAPD Comprehensive Formulary are provided for informational purposes only. They do not indicate coverage. Use this section as a reference tool to assist you in identifying if a particular drug is on the formulary. Formulary brand name drugs are indicated in all capital letters while those drugs in lower case with the brand name in parentheses indicate that only the generic is on formulary.
If you need assistance finding a drug, call Customer Service at 800-996-6250 (TTY 800-750-0750).
Looking for a specific prescription drug? Search the online Find a Drug tool.
Personal Prescription Information
Visit the MedImpact website and log in and review your prescription copay information, mail service details and your prescription history. Click here to visit the MedImpact website.
2013 Medication Therapy Management Program
If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by SummaCare at no additional cost to you! The MTM program is required by the Centers for Medicare and Medicaid Services (CMS). This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.
Click here to view the 2013 MTM Program Description to see if you qualify. You can also download a copy of a Personal Medication List to help you keep track of your medications and how to use them the right way. This list can also be shared with your physicians and pharmacist.
Click here to view the 2014 MTM Program Description.
MedVantx: Prescription Drug Mail Service
The convenience of mail service delivery will be available through the MedVantx Mail Service website where you can set up your account and order online! You may be able to save money on your prescription drug copays by ordering your maintenance drugs through the MedVantx Mail Service. Visit MedVantx to register today or download and print the Registration and order forms.
What is a Formulary?
A formulary is a list of covered drugs selected by SummaCare in consultation with a team of healthcare providers. The formulary represents the prescription therapies believed to be a necessary part of a quality treatment program. SummaCare Secure will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at an SCSecure network pharmacy and other plan rules are followed.
SummaCare Secure covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as brand name drugs. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Can the Formulary Change?
Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
If we remove drugs from our formulary or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
2013 Prior Authorization Requirements
2013 Step Therapy Requirements
2013 Transition Process Appeals and Grievances Information
Last Updated: 04/23/2013