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
Formulary Changes Effective July 1, 2018
Formulary Changes Effective August 1, 2018
Formulary Changes Effective September 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: 08/01/2018