Part D Prescription Drug Coverage
Piedmont Medicare Advantage contracts with and utilizes the services of CVS Caremark for its Part D prescription drug coverage. Piedmont Select Medicare Option One (PPO) and Piedmont Select Medicare Option Two (PPO) both include Part D prescription drug coverage and have contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. The pharmacy network includes local pharmacies in the area as well as most national chain pharmacies, including CVS, Wal-Mart, K-Mart, Kroger, Target, The Medicine Shoppe, and Walgreens.
For a complete listing of participating pharmacies or to find one near you, use our Pharmacy Locator.
The Part D prescription drug coverage is the same for Piedmont Select Option One and Piedmont Select Option Two. The coverage follows a formulary and has four tiers. Tier One is for generic drugs, Tier Two is for preferred brand name drugs, Tier Three is for non-preferred brand name drugs and Tier Four is for specialty drugs.
For more information on the formulary and which drugs are on which tier, use our Formulary Search Tool.
2012 Formulary “Drug List” (Printable Format - Updated Monthly)
Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan’s service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy’s full charge for the drug and submit documentation to receive reimbursement from Piedmont Select Medicare Option One or Piedmont Select Medicare Option Two. For a description of the prescription drug benefits, please refer to the Summary of Benefits “Prescription Drug” section.
2012 Summary of Benefits
Outpatient Prescription Drug Benefits can be found on page 30.
Other helpful topics of information for your Part D prescription drug coverage:
- Prior Authorization Criteria
- Step Therapy Criteria
- Drug Utilization Management
- Quality Assurance Policies and Medication Therapy Management (MTM)
Transition Policy
2012
- Piedmont Select Medicare Option One Transition Policy (page 92, Chapter 5, Section 6.2 of the Evidence of Coverage)
- Piedmont Select Medicare Option Two Transition Policy (page 92, Chapter 5, Section 6.2 of the Evidence of Coverage)
- Grievance and Appeals Information
Forms you may need:
To get the most up-to-date information call our Customer Service Department at one of the telephone numbers listed below, 24 hours a day, seven days a week.
- Customer Service toll free number: (866) 494-9927
- TTY users should call (866) 236-1069
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information is available to assist you in making a decision about your coverage.
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H1659_WebRev2012 CMS Approved 12302012
Last updated 05/01/2012
