Frequently Asked Questions
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year.
Formulary (Drug List) Questions
What things does a Medicare prescription drug plan cover?
In general, Medicare prescription drug plans (also called "Part D" plans) cover a variety of drugs, including generics, brands, and specialty drugs. These plans also cover some vaccinations. These drugs are listed on the plan's Formulary (Drug List) which has been approved by the federal agency that manages the Medicare program (the Centers for Medicare and Medicaid Services (CMS)).
Are diabetic supplies covered by the Medicare prescription drug plan?
Insulin and some other diabetic supplies are covered by your Medicare prescription drug plan. However, diabetes testing supplies (such as test strips and lancets) are covered under Medicare Part B or other medical (non-prescription drug) coverage.
What types of drugs are not covered by the Medicare prescription drug plan?
Here are three general rules about drugs that Medicare drug plans will not cover under Part D:
Also, by law, these categories of drugs are not covered by Medicare drug plans:
Pharmacy Access Questions
How do I transfer a prescription from a non-network pharmacy to one of the plan's network pharmacies?
There are three ways to transfer your prescription:
Can I fill my prescriptions at a retail pharmacy and through mail order at the same time?
You can fill your prescriptions at your choice of network retail pharmacy, mail order, and/or a participating Choice90Rx pharmacy as you wish. For example, you could get some 90-day prescriptions filled by mail order, and other 90-day prescriptions filled at a participating Choice90Rx pharmacy. You don't have to use any one source for all of your drugs. The Medicare GenerationRx claims system reviews your personal medication profile each time you get a prescription filled to check for duplicate prescriptions to make sure you are getting the prescriptions you need when you need them.
Depending on the type of medication, you can choose more than one option to fill your prescriptions.
For more information, call Member Services toll-free at 1-877-MEDRXHELP (1-877-633-7943) 24 hours a day, 365 days a year. TTY/TDD users should dial 711.
Who should I contact about pharmacy issues?
If you should encounter any issues at a participating pharmacy, please contact Member Services immediately toll-free at 1-877-MEDRXHELP (1-877-633-7943), 24 hours a day, 365 days a year. TDD/TTY users should dial 711.
Cost Sharing Questions
In addition to your monthly premium, you will pay an additional amount when drugs are received.This amount is your share of the cost of the drugs, also called cost sharing. Please see your Summary of Benefits and your Evidence of Coverage for information about your cost sharing.
How do I find out the costs of my prescription drugs?
You can determine how much a medication may cost you by clicking on either the Benefit Highlights or Drug Price Check link located in the menu bar.
Note that you will need to be a registered user of the member web site to view Benefit Highlights or Drug Price Check. Registering is easy! Simply click on the Register Now link on the home page and enter your first and last name, member ID#, and birth date.
You may also get assistance by calling Member Services toll-free at 1-877-MEDRXHELP (1-877-633-7943), 24 hours a day, 365 days a year. TDD/TTY users call 711.
What if the cost share amounts that are displayed in Benefit Highlights seem different from what was outlined in my plan documents?
Benefit Highlights displays your current copayment amounts and, if applicable, your deductible and maximum out-of-pocket expenses. Additional or different cost-sharing amounts may be applied to certain therapeutic categories, specific drug classes, or individual drugs, and these amounts may not be represented on the Benefit Highlights table. For more detailed information, refer to your Evidence of Coverage. After considering this you still believe the amounts displayed are incorrect, call Member Services toll-free at 1-877-MEDRXHELP (1-877-633-7943), 24 hours a day, 365 days a year. TDD/TTY users call 711.
Are there any differences in my copayment amounts when using mail order or the 90-day retail program called Choice90Rx?
If you take a medication on an ongoing basis, you may be able to save money when you obtain up to a 90-day supply of medication at mail order or the 90-day retail program called Choice90Rx. Up to a 90-day supply of your prescriptions can generally be obtained for less than what you would pay if you filled a 30-day supply of your prescriptions each month. To view your copayment amounts, click on "Benefits Highlights" on the menu bar.
How does the Coverage Gap (Donut Hole) Discount Program work?
Most Medicare drug plans have a Coverage Gap (also called the "Donut Hole"). This means there's a temporary limit on what the drug plan will cover. Not everyone will enter the Coverage Gap. The Coverage Gap begins after you and your drug plan have spent a certain amount for covered drugs. Please refer to your Summary of Benefits and Evidence of Coverage for more information about these amounts.
The amount you pay in the Coverage Gap depends on the benefit design selected by your employer group. If your employer group offers Gap Coverage, the discounts listed below may already be factored into your cost sharing and premiums. If you have Generic Only coverage in the Gap, you will continue to pay your generic cost share for generic drugs and get the brand discount listed below for Brand drugs. If you have full coverage in the Gap, you will continue to pay the same cost share for Generic and Brand drugs in the Coverage Gap.
If your benefit has a Coverage Gap, the Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D enrollees who have reached the Coverage Gap and are not already receiving "Extra Help". The plan also provides generic discounts during the Coverage Gap. The percentage you save in the Coverage Gap will increase each year through 2020 as outlined in the tables below.
Brand Drugs during the Coverage Gap:
During the Coverage Gap, you get a discount on the negotiated price (excluding the dispensing fee and vaccine administration fee, if any) for those brand name drugs from manufacturers that have agreed to participate in the program. Both the amount you pay and the amount discounted by the manufacturer count toward your out-of-pocket costs as if you had paid them. This moves you through the Coverage Gap to the Catastrophic Coverage stage.
Generic Drugs during the Coverage Gap:
For generic drugs, the amount paid by the plan does not count toward your out-of-pocket costs. Only the amount you pay counts and moves you through the Coverage Gap to the Catastrophic Coverage stage. The dispensing fee is included as part of the cost of the drug.
If you reach the Coverage Gap, we will automatically apply the discount when your pharmacy bills you for your prescription and your Monthly Prescription Drug Summary will show any discount provided.
Some employer groups provide a benefit with coverage through the Donut Hole. If you have any questions about the availability of discounts for the drugs you are taking or about the Medicare Coverage Gap Discount Program in general, please contact Member Services toll-free at 1-877-MEDRXHELP (1-877-633-7943), 24 hours a day, 365 days a year. TDD/TTY users call 711.
Plan and Benefit Questions
Do I really need Medicare Prescription Drug Coverage?
Even if you only take a few medications, the cost of those prescription drugs can be significant if paid for out-of-pocket and will likely go up every year. And, even one unexpected illness can increase those costs dramatically. The coverage provided by a Medicare prescription drug plan can reduce those costs to more predictable, manageable amounts and give you peace of mind should an illness arise.
Do I need to enroll in a Medicare Part D prescription drug plan if I am enrolled in Medicare GenerationRx (Employer PDP)?
Medicare GenerationRx (Employer PDP) was carefully chosen by your former employer for Medicare Part D group retiree prescription drug coverage. You are only enrolled in one Medicare Part D prescription drug plan at a time. If you are currently enrolled in another Part D plan, you will automatically be disenrolled from that plan when you enroll in Medicare GenerationRx.
Does my pharmacy benefit cover every medication prescribed by my health care provider?
Your pharmacy benefit may not cover all medications prescribed by your health care provider. Some medications may be excluded from coverage. Exclusions may include, but may not be limited to, over-the-counter (OTC) medications, drugs used for erectile dysfunction, or any drug products used for weight loss or other cosmetic purposes.
To determine if a medication is covered by your pharmacy benefit, click on the Drug Price Check link located on the home page and enter your criteria. Drug Price Check will indicate if a medication is not covered (NC) in the status column of the formulary table.
For more detailed information, refer to your Medicare GenerationRx (Employer PDP) Formulary (List of Covered Drugs) and Evidence of Coverage.
How soon can I get a refill?
If your health care provider allows for a prescription refill, you generally need to finish 75% of your days' supply before you are able to get your next refill. For example, if your prescription is for 30 days, you need to finish 23 days before you can refill your prescription. Your pharmacist can work with us to provide an override if you need to refill a prescription early.
Are all my prescriptions checked for drug interactions?
At the pharmacy, your pharmacist has the duty to use his or her professional judgment to assess the chance of your prescription having a drug interaction with other drugs you are taking. If you use your Medicare GenerationRx Member ID Card when you obtain a medication, information about each drug is also sent to our claims system and reviewed for any potential drug interactions based on your personal medication profile before your claim is approved by our systems. If the claims system identifies a potential drug interaction, a notice will be sent electronically to the pharmacist filling your prescription for their review and consideration.
What should I do if I have other insurance in addition to Medicare?
If you or your spouse has, or is able to get, employer group coverage other than this group plan, you should talk to the group's benefits administrator to find out how any benefits you get from the other employer group will be affected if you join Medicare GenerationRx. Get this information before you decide to enroll in this or any other plan.
What should I do if I can't afford my prescription drugs?
Medicare provides "Extra Help" to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan's monthly premium and prescription copayments or coinsurance. This Extra Help also counts toward your out-of-pocket costs. People with limited income and resources may qualify for Extra Help. Some people automatically qualify for Extra Help and don't need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.
There are various other programs to help people with specific health conditions and who meet certain criteria to get help through State Pharmaceutical Assistance Programs, drug manufacturer's programs, and other programs for those who qualify. To see if you qualify for getting Extra Help or to check the status of your application, call:
How do I request a replacement ID card?
If your ID card gets lost, stolen or damaged and you want to request a replacement card, please call Member Services toll-free at 1-877-MEDRXHELP (1-877-633-7943), 24 hours a day, 365 days a year. TDD/TTY users call 711. If you need to fill a prescription immediately and cannot wait for your replacement ID card to arrive, explain this when you call and we can contact your pharmacy to provide them with the necessary information they'll need to process your claim(s) until your new ID card arrives.
What internet browser should I use?
Medicare GenerationRx's Member Web Site will perform best if you use Microsoft Internet Explorer version 8 or 9 or Firefox version 18 or above. Visit www.microsoft.com for Internet Explorer upgrades or www.firefox.com for Firefox upgrades.
What additional advantages can I expect from registering online?
Medicare GenerationRx's member website is a resource that can keep you up-to-date about your pharmacy benefits. With an easy, one-time registration, you will have access to pharmacy benefit information that is specific to you, as well as up to 28 months of pharmacy claims history. Once you are a registered user, all you need to do is sign in with a username and password each time you visit the Medicare GenerationRx member website.
Stonebridge Life Insurance Company (a Transamerica Company) is a PDP plan sponsor with a Medicare contract.
Enrollment in this plan depends on contract renewal.