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Plan Central - your source for benefit information
Home > SummaCare Medicare Member > Medical Benefits > Drug Benefits Information

Drug Benefits Information

What Drugs Are Covered?

2018 Comprehensive Formulary (Complete list of covered drugs) Effective January 1, 2018

Formulary Changes Effective June 1, 2018

If you need assistance finding a drug, call Customer Service at 800-996-6250

(TTY 800-750-0750). From October 1 through February 14, a representative will be available to take your call from 8:00 am until 8:00 pm, seven days a week. From February 15 through September 30, a representative will be available to take your call from 8:00 am until 8:00 pm, Monday through Friday. Outside these hours, you may leave us a message and a representative will return your call the next business day.

What Pharmacies Are Included?

Learn what pharmacies are in our network and search for pharmacies by visiting our Pharmacy Information page.

Personal Prescription Information

Visit Plan Central to log in and review your prescription copay information, mail service details and your prescription history.

Vaccine Coverage

Most preventive vaccines are covered under Medicare Part D Prescription Drug Coverage while a few are covered under the Part B Medical Coverage. It’s important to know what vaccines are covered, your potential out-of-pocket costs and where to get your vaccine. Learn more about vaccine coverage.

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 program, or MTM. MTM is a clinical program that provides education and information about your medications. It is designed to ensure that covered Part D drugs prescribed to targeted members are appropriately used to optimize therapeutic outcomes through improved medication use and to reduce the risk of adverse events, including adverse drug interactions. 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).

View the 2018 MTM program information here.

MedImpact Direct: Prescription Drug Mail Service

As a valued SummaCare member, we are happy to bring you a new program for getting your routine prescription drugs delivered to your home through MedImpact Direct. The MedImpact Direct program is designed to reduce costs, ensure satisfaction and improve the convenience of home delivery while helping to manage the costs of your prescription drugs. Learn more about MedImpact Direct or download and print the order form.

What is a Comprehensive Formulary?

A comprehensive formulary is a list of all 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 will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy and other plan rules are followed.

SummaCare 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.

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.

2018 Transition Process

Appeals and Grievances Information

2018 Step Therapy Requirements

2018 Prior Authorization Requirements

Last Updated: 03/30/2018

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H3660_18_112 CMS Approved 11/22/2017 | ©2017 SummaCare, Inc.  |  10 North Main Street, Akron, Ohio 44308 | SummaCare is an HMO and HMO-POS plan with a Medicare contract. Enrollment in SummaCare depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitation, copayments and restrictions may apply. Benefits, premiums, copayments and coinsurance may change on January 1 of each year. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. 

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