PPO II - EmblemHealth

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2013 Evidence of Coverage for PPO II) II SECTION Chapter 5: 3 Using What the benefi plan’s ts are coverage not covered for your by the Part plan? D prescription drugs Section 9.3 What if you’re also getting drug coverage from an employer or retiree group plan? Do you currently have other prescription drug coverage through your (or your spouse’s) employer or retiree group? If so, please contact that group’s benefi ts administrator. He or she can help you determine how your current prescription drug coverage will work with our plan. In general, if you are currently employed, the prescription drug coverage you get from us will be secondary to your employer or retiree group coverage. Th at means your group coverage would pay fi rst. Special note about ‘creditable coverage’: Each year your employer or retiree group should send you a notice that tells if your prescription drug coverage for the next calendar year is “creditable” and the choices you have for drug coverage. If the coverage from the group plan is “creditable,” it means that the plan has drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Keep these notices about creditable coverage, because you may need them later. If you enroll in a Medicare plan that includes Part D drug coverage, you may need these notices to show that you have maintained creditable coverage. If you didn’t get a notice about creditable coverage from your employer or retiree group plan, you can get a copy from the employer or retiree group’s benefi ts administrator or the employer or union. SECTION 10 PROGRAMS ON DRUG SAFETY AND MANAGING MEDICATIONS Section 10.1 Programs to help members use drugs safely We conduct drug use reviews for our members to help make sure that they are getting safe and appropriate care. Th ese reviews are especially important for members who have more than one provider who prescribes their drugs. We do a review each time you fi ll a prescription. We also review our records on a regular basis. During these reviews, we look for potential problems such as: • Possible medication errors • Drugs that may not be necessary because you are taking another drug to treat the same medical condition • Drugs that may not be safe or appropriate because of your age or gender • Certain combinations of drugs that could harm you if taken at the same time • Prescriptions written for drugs that have ingredients you are allergic to • Possible errors in the amount (dosage) of a drug you are taking. If we see a possible problem in your use of medications, we will work with your provider to correct the problem. 99
100 2013 Evidence of Cover age for PPO II Chapter 5: Using the plan’s coverage for your Part D prescription drugs Section 10.2 Programs to help members manage their medications We have programs that can help our members with special situations . For example, some members have several complex medical conditions or they may need to take many drugs at the same time, or they could have very high drug costs. Th ese programs are voluntary and free to members. A team of pharmacists and doctors developed the programs for us. Th e programs can help make sure that our members are using the drugs that work best to treat their medical conditions and help us identify possible medication errors. If we have a program that fi ts your needs, we will automatically enroll you in the program and send you information. If you decide not to participate, please notify us and we will withdraw you from the program. If you have any questions about these programs, please contact Customer Service (phone numbers are printed on the back cover of this booklet).
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55 Water Street, New York, New York
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PPO II - EmblemHealth

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