Frequently Asked Questions About HOP Covered Drugs and Filling Prescriptions

• What prescription drugs does HOP cover?
• Where can I get my prescriptions filled?
• How much do I have to pay when getting prescriptions filled?
• How will the pharmacist know what to charge me?
• Can I get a 90-day supply of my drugs?
• How can I find out how much a drug will cost under the Basic or Enhanced Medicare Rx Options?
• If I am currently taking a non-formulary drug, what do I need to do to ensure I maximize my HOP prescription drug benefits?
• What happens if I currently get my drugs from abroad?
• What if I'm in a state pharmacy assistance program?
• What if I get free drugs from a drug manufacturer's patient assistance program?
• What does QLL or quantity limit mean?
• What is step therapy?

What prescription drugs does HOP cover?

For information about prescription drugs covered through the Basic or Enhanced Medicare Rx Option, download the HOP abridged and/or comprehensive formulary.

Where can I get my prescriptions filled?

Under the Basic and Enhanced Medicare Rx Options, you have access to pharmacies in every state. For information about participating pharmacies, call 1-888-239-1301 or click here.

How much do I have to pay when getting prescriptions filled?

Under the Basic and Enhanced Medicare Rx Options, you pay no deductibles for prescription drugs, just a copay or coinsurance, depending on the type of drug (generic, brand-name with or without a generic equivalent, or a Specialty drug).

For a side-by-side cost comparison of the Basic and Enhanced Medicare Rx Options, see page 8 of the 2009 Welcome to HOP brochure.

How will the pharmacist know what to charge me?

Present your prescription drug card at the pharmacy (or send the identifying information requested if you're using mail order). The pharmacist will then be able to electronically access information regarding all prescription drugs obtained after presenting your prescription drug identification card or purchased through the mail service pharmacy. This central data base will indicate what your copay should be.

Can I get a 90-day supply of my drugs?

Yes. All of the HOP Options offer a mail-order prescription drug program, which provide up to a 90-day supply of your medication. Some retail pharmacies also offer a 90-day supply. Please note: a pharmacy must have an agreement with Prescription Solutions regarding dispensing a 90-day supply before your 90-day prescription can be filled.

How can I find out how much a drug will cost under the Basic or Enhanced Medicare Rx Options?

The amount you pay will depend on the type of drug (generic, brand or Specialty) you purchase. For a side-by-side cost comparison of the Basic and Enhanced Medicare Rx Options, see page 8 of the 2009 Welcome to HOP brochure.

If I am currently taking a non-formulary drug, what do I need to do to ensure I maximize my HOP prescription drug benefits?

You should talk with your provider to determine if the non-formulary drug you are taking can be replaced with a formulary drug. Click here for information about the formulary for the Basic and Enhanced Medicare Rx Options. If your provider determines that there is not a formulary drug that can be substituted, your provider must call Prescription Solutions at 1-888-239-1301 to request an exception.

What happens if I currently get my drugs from abroad?

HOP does not cover drugs bought from Canada or other countries.

What if I'm in a state pharmacy assistance program?

Your state pharmacy assistance program may coordinate with Medicare prescription drug coverage to give you greater savings. Check with your state program or contact your state health insurance counseling program. If you currently get your drugs through Medicaid, you automatically qualify for extra help.

What if I get free drugs from a drug manufacturer's patient assistance program?

You can still do so and have Medicare Prescription Drug Coverage too—as long as the manufacturer's program continues this help for people on Medicare. Check with the drug manufacturer company.

What does QLL or quantity limit mean?

Your plan's Drug Quantity Management program is designed to help you get the medicines you need when you need them, in safe, economical amounts, while taking your special needs into account. The program follows guidelines developed by the U.S. Food and Drug Administration (FDA), medical researchers and drug manufacturers. These professionals recommend the maximum quantities considered safe, especially for those drugs where it is difficult to decide on the proper dose. As a result, some drugs have quantity limits.

By making sure you only get the recommended amount of your medications when you request a refill, Drug Quantity Management not only safeguards your health, it also helps you save money. When you request a prescription, you will receive the quantity prescribed by your doctor not to exceed the recommended amount, which should last until it's time for a refill. If you regularly need refills sooner than recommended, you may be using too much of your medication and should contact your doctor. He or she may be able to suggest ways you can use your medication so you don't have to refill—and pay for—your prescriptions as often.

What is step therapy?

Step therapy is a program designed for people who take prescription drugs regularly to treat an ongoing medical condition (for example, arthritis, asthma, or high blood pressure). In step therapy, the covered drugs you take are organized in a series of "steps." Each step is a different category of drug, such as first-step treatments and second-step treatments.

The program usually starts with requiring coverage for the "first-step drug." This first step allows you to begin or continue treatment with prescription drugs that are appropriate for you, but more proven than drugs in the "second step."

If your doctor determines the first-step drug does not work for you, you can receive coverage for a second-step drug.