Managing Prescription Drugs with HMSA Medicare Advantage Plans
Efficiently managing your prescription drugs is a significant part of your healthcare journey. Certain HMSA Medicare Advantage plans will likely include different tiers for prescription drug coverage, with potential co-payments that may vary based on whether medications may be obtained through retail or mail-order pharmacies during the initial coverage stage.
After surpassing the initial coverage limit, you enter the catastrophic coverage stage, which could potentially provide additional coverage for prescription drugs.
Coverage determinations by HMSA will likely be crucial decisions about whether a Part D drug may be provided or paid for, and these determinations may also involve making exceptions to the usual formulary list. So, it’s not just about getting your medications, it’s about making sure you could get the most appropriate and cost-effective medications.
Formulary and Drug Search Tools
With the possibility of having a comprehensive formulary that lists all drugs covered by the plan, you might easily find your prescribed medications. But did you know you could also find potential cost-saving alternatives?
Generic drugs may contain the same active ingredients as brand-name drugs, offering potential cost savings while providing the same therapeutic benefits.
Some of these generic alternatives may be introduced after the patent for the brand-name drug expires, usually after 20 years. So, by choosing available generic alternatives, you may be able to take advantage of the potential cost savings while receiving the same therapeutic benefits as the brand-name medications. It’s all about getting the best value for your money.
Mail-order Prescription Service
Getting your medications may now be as simple as checking your mail. With the CVS Caremark mail-order prescription service, you could have some of your medications delivered directly to your home. This service may be specifically designed for the delivery of maintenance medications that may be used for the treatment of chronic conditions.
So, if you’re managing a chronic condition, this service might be a convenient option for you. All you may need to do is order your medications and you could have them delivered straight to your doorstep.
Prior Authorization and Step Therapy
Sometimes, obtaining certain prescription drugs may require prior authorization. This process may ensure that you receive the most appropriate and cost-effective medications. There may also be the Step Therapy measure where you might need to try one or more preferred drug alternatives to determine effectiveness before being approved for a non-preferred drug.
But don’t worry, if you’re already undergoing treatment, Step Therapy protocols could potentially maintain continuity of care by not requiring a switch to preferred drug alternatives. So, these possible provisions for prior authorization and step therapy may be able to ensure appropriate medication use, keeping your health as the top priority.
Potential Financial Assistance for HMSA Medicare Advantage Plan Members
While healthcare costs may be worrisome, HMSA Medicare Advantage plan members may be able to avail of financial assistance programs such as Extra Help and the Low-Income Subsidy. Members who qualify for Extra Help may receive assistance with monthly premiums, annual deductibles, and prescription drug copayments.
These potential financial assistance programs may be able to ensure that your healthcare needs don’t have to take a toll on your finances. All you need to do is submit your applications for financial assistance to the Social Security Administration either online or at a local office.
Low-Income Subsidy Program
The Low-Income Subsidy, also known as the Extra Help program, will likely be a federal program that could potentially provide support to eligible Medicare beneficiaries with some of their medication expenses. This program could potentially reduce some out-of-pocket costs by paying for prescription drugs and possibly lowering monthly plan premiums for those who qualify.
Eligibility for the Low-Income Subsidy may be determined by income and assets, with considerations for higher income and resource limits that may be specific to residents of Hawaii.
Once Medicare notifies HMSA that you’re eligible for the Low-Income Subsidy, the subsidy is applied to your plan, potentially reducing some of your prescription drug copayments and monthly premiums.
Extra Help
The Extra Help program may be able to assist eligible individuals with potential Medicare Part D prescription drug plan costs, which could include premiums, deductibles, and co-payments.
Eligibility for Extra Help will likely require that you have Medicare, have limited resources and income from sources such as wages and benefits, and reside in one of the 50 states or the District of Columbia, possibly excluding the value of a primary residence if lived in.
To avail of Extra Help, you could apply via the Social Security Administration website, by phone, or by visiting a local Social Security office. So, don’t let potential financial constraints hinder your healthcare journey. Take advantage of the Extra Help program and you could potentially ease some of your healthcare costs.