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2006 Service Area Marion County and Broward County Benefits - Contract H5427, Plan 001: You pay the following for prescription drugs you receive from an in-network preferred pharmacy:
You pay the following for prescription drugs you receive through our mail-order program:
There is no coverage limit for your prescription drugs. After your yearly out-of-pocket drug costs reach $3,600, you pay the greater of: $2 for generic or a multi-source preferred brand drug and $5 for all other drugs OR 5% coinsurance. Miami-Dade County Benefits - Contract H5427, Plan 002 : You pay the following for prescription drugs you receive from an in-network preferred pharmacy:
You pay the following for prescription drugs you receive through our mail-order program:
There is no coverage limit for your prescription drugs. After your yearly out-of-pocket drug costs reach $3,600, you pay the greater of: $2 for generic or a multi-source preferred brand drug and $5 for all other drugs OR 5% coinsurance. Cost Sharing : The Freedom Health - Freedom Medicare Plan has no deductible. The member is responsible for the co-payments and/or co-insurance described under the benefits. You may receive additional information on the six prescription benefit tiers and their applicable co-payments by calling the Freedom Health Member Services Department at (800) 401-2740 or TTD/TTY at (800) 955-8771. Applicable Conditions and Limitations : There is no coverage limit for your prescription drugs. After your yearly out-of-pocket drug costs reach $3,600, you pay the greater of : $2 for generic or a preferred brand multi-source drugs OR 5% co-insurance. Conditions Associated with Receipt or Use of Benefits : Your provider must get prior authorization from Freedom Health for certain prescription drugs. Contact the Member Services Department at (800) 401-2740 or TTD/TTY at (800) 955-8771 for details. Formulary : This plan uses a formulary. A formulary is a preferred list of drugs selected to meet patient needs at a lower cost. If the formulary changes, you will be notified, in writing, 60 days prior to the removal or change in the preferred or tiered cost-sharing status of a Part D drug. For information on the drugs included in the Freedom Health Freedom Medicare Plan formulary please click here. Pharmacy Access : The Freedom Health - Freedom Medicare Plan meets access requirements through contracts with pharmacies that equals or exceeds Centers for Medicare and Medicaid Services (CMS) requirements for pharmacy access in your area. For information on in-network preferred pharmacies, please click here. You will find pharmacy addresses and types of pharmacies (retail, mail-order and home infusion) at this location. Freedom Health currently has over 200 in-network preferred pharmacies as of January 1, 2006. Out-of-Network Coverage : As a member of the Freedom Health Freedom Medicare Plan, you have out-of-network pharmacy coverage ONLY for urgent and emergency medical needs. Coverage Determinations and Exceptions Process : The plan may grant an exception whenever it determines that the non-preferred drug for treatment of the enrollee's condition is medically necessary, consistent with the prescribing physician's oral or written statement which includes: (1) the preferred drug would not be as effective for the enrollee as the requested drug or (2) the preferred drug would have adverse effects for the enrollee. The Plan's formulary exceptions process addresses the following circumstances:
Exceptions criteria include, but are not limited to: (1) Consideration of whether the requested non-preferred drug is the therapeutic equivalent of any other drug on the plan's formulary and/or (2) Consideration of the number of drugs on the plan's formulary that are in the same class and category as the requested prescription drug that is the subject of the exceptions request. Medication Therapy Management (also referred to as medical quality management) : Freedom Health has instituted a "medical quality management" review at the point when a prescription is filled that is designed to check the member's prescription history for any possible drug conflicts. A partial list of the screening items includes: dosage screening, allergy screening, compliance screening, drug-drug interactions (major, moderate, severe), drug-diagnosis cautions (based on health profile of the member for conflicts between diagnoses and drug prescribed), dosage duration, drug-age screening, and drug-sex screening. These medical quality monitoring mechanisms are reviewed at least annually for modification. |
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Welcome to the Freedom Health Part D Prescription benefit page for all participating counties! 