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Am I eligible for Prescription Pathway? |
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If you are enrolled in Medicare Part A or Part B, you are eligible for Prescription Pathway plans. Our plans are available nationally.You may be enrolled in only one Medicare prescription drug plan at a time. |
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Can I switch to Prescription Pathway if I'm already enrolled in another Medicare prescription drug plan? |
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Yes. You are allowed to switch Medicare drug plans between November 15 and December 31. You may be able to save more by switching to a Prescription Pathway plan. Give us a call and we can tell you within a matter of minutes. There are other times when you may be able to switch plans, like if you move to another state. And if you are eligible for both Medicare and Medicaid, you can switch at any time.
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Does Prescription Pathway pay for all drugs? |
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No. But Prescription Pathway covers every class of prescription drug as allowed by Medicare Part D. Our plans have a formulary, a list of brand name and generic drugs that are covered. Use the formulary search or give us a call to find out if your drugs are covered.
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What if my prescription drug is not on the formulary? |
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If your specific medication is not on our formulary, there might be a similar drug that offers the same benefits. For example, if you're taking a high blood pressure drug, there might be a suitable alternative on our formulary. We'll work with you and your doctor to find a covered drug that best meets your needs.
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When can I enroll and when will my coverage be effective? |
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For most people, the time to sign up for a Prescription Pathway plan is during the annual enrollment period, November 15-December 31, 2007. If you sign up during this time, your coverage will be effective January 1, 2008.
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Can I still sign up if I didn't enroll during the annual enrollment period? |
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You may be able to enroll in a prescription drug plan at other times outside the annual enrollment period, such as if you are turning 65, qualify for Medicaid or are moving. You may also qualify for a special enrollment period if you move into, reside in or move out of a long-term care facility. Call us at the number below to learn more.
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What is the coverage gap? |
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The coverage gap, also referred to as the "donut hole" or the "gap", is a standard guideline set by Medicare. After your total yearly drug costs–paid by you and your drug plan–have reached $2,510, you are responsible for paying 100% of your prescription costs until you have paid $4,050 in yearly out-of-pocket costs. Some plans, like Prescription Pathway's Platinum Plan, offer generic drug coverage during the coverage gap.
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What if I have prescription drug coverage from an employer or union? |
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Check with your employer or union to determine how much your current plan covers compared to a Prescription Pathway plan.
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What if I don't become eligible for Medicare until after December 31, 2007? |
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No problem. Medicare will inform you of the dates of your seven-month open enrollment period, which is the same as your enrollment period for Medicare.
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What are my rights and responsibilities if I am ever disenrolled? |
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Under certain circumstances, you may be disenrolled from your Prescription Pathway plan. These circumstances may include not paying your plan premium, misusing your plan benefits or if Prescription Pathway's contract with CMS is not renewed. If you are disenrolled, all of your Prescription Pathway benefits and plan rules will continue until your membership ends, and you must continue to get your prescriptions through Prescription Pathway's network pharmacies. Upon disenrollment, you may join another Medicare prescription drug plan or a Medicare Advantage plan with prescription drug coverage, as long as these plans are available in your area and are accepting new members.
Prescription Pathway has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract may be renewed each year. However, Prescription Pathway or CMS can decide to end the contract at any time. You will generally be notified 90 days in advance if this situation occurs. However, your advance notice may be fewer than 30 days if CMS ends our contract in the middle of the year.
Once we have notified you in writing that we are leaving the Medicare program or the area where you live, you may enroll in another plan. Consult the Prescription Pathway Evidence of Coverage, or call Medicare at 1-800-MEDICARE (TTY for the hearing impaired 1-877-486-2048) for specific information on special enrollment periods.
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Don't see your question listed here? Give us a call at 1-877-269-1151 (TTY for the hearing impaired 1-866-222-3904), 8 a.m.-11 p.m. Eastern Time, seven days a week. We'll be happy to help you with any question or concern.
