Prescription Convenience
KelseyCare Advantage Rx and KelseyCare Advantage Rx+Choice have contracted with Prescription Solutions, a pharmacy benefits administrator, to provide you with access to a broad pharmacy network, prescription savings and benefit administration. When you choose KelseyCare Advantage Rx and KelseyCare Advantage Rx+Choice, you will have access to more than 1,000 retail, home infusion and long-term care pharmacies within the KelseyCare Advantage service area. You will also have prescription drug coverage.
KelseyCare Advantage Rx and KelseyCare Advantage Rx+Choice uses a Drug Formulary (a list of prescription drugs approved for coverage by KelseyCare Advantage).
To determine whether your medications are on our Formulary, click here to download a PDF of our 2009 Abridged Drug Formulary.
You may also search our Formulary by the first letter of the drug name.
Quick Answers
Does my plan cover Medicare Part B drugs or Part D drugs?
KelseyCare Advantage Rx and KelseyCare Advantage Rx+Choice cover a limited number of Medicare Part B drugs, all Medicare Part D drugs and some prescription drugs that are not normally covered in a Medicare Prescription Drug Plan.
KelseyCare Advantage Essential and KelseyCare Advantage Essential+Choice only cover Medicare Part B drugs, and does NOT cover Medicare Part D drugs.
What is a prescription drug formulary?
A formulary is a list of drugs covered by our plan to meet our KelseyCare Advantage Rx and KelseyCare Advantage Rx+Choice members’ prescription drug needs. The drugs on our formulary are selected by a KelseyCare Advantage healthcare team of experts to provide prescription drug therapies that are believed to be a necessary part of a quality treatment program.
Can the formulary change?
We may make certain changes to our formulary during the year. Changes in the formulary may affect which drugs are covered and how much you will pay when filling your prescription. The kinds of formulary changes we may make include:
- Adding or removing drugs from the formulary;
- Adding prior authorizations, quantity limits, and/or step therapy restrictions on a drug
- Moving a drug to a higher or lower cost-sharing tier
If we remove drugs from the formulary, or add prior authorizations, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier and you are taking the drug affected by the change, you will be permitted to continue taking that drug at the same level of cost sharing for the remainder of the plan year. However, if a brand name drug is replaced with a new generic drug, or our formulary is changed as a result of new information on a drug's safety or effectiveness, you may be affected by this change. We will notify you of the change at least 60 days before the date that the change becomes effective or provide you with a 60-day supply at the pharmacy. This will give you an opportunity to work with your physician to switch to a different drug that we cover or request an exception. If a drug is removed from our formulary because the drug has been recalled from the pharamcies, we will not give 60 days notice before removing the drug from the formulary. Instead, we will remove the drug immediately and notify members taking the drug about the change as soon as possible.
For questions regarding the formulary, please call Prescription Solutions Customer Service 24 hours a day, 7 days a week, toll free at 1-888-242-1009. TTY/TDD 1-866-394-7218.
How can I get extra help with my prescription drug plan costs?
If you have limited income and resources, you may qualify for extra help to pay your Medicare prescription drug costs. For more information about applying for extra help, call Social Security at 1-800-772-1213 between the hours of 7 a.m. and 7 p.m., Monday-Friday (TTY/TDD 1-800-325-0778).
Where can I get information about Low Income Subsidy?
Click here to learn more about Medicare's Best Available Evidence policy.
