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2014 Formulary Updates

Senior Care Plus uses a formulary under its qualified prescription drug coverage and it meets the Center's for Medicare & Medicaid Services (CMS) requirements for the following: Pharmacy and Therapeutics committee; Provision of an adequate formulary; Transition process; Limitation on changes in therapeutic classification; Provision of notice regarding formulary changes; Limitation of formulary changes prior to beginning of contract year; Provider and patient education; and Formulary changes during the contract year. 

Listings of drugs covered on this plan and pharmacies you can access are provided in the
Pharmacy Handbook - View Original Document  and Updated Formulary
For the most up-to-date Formulary information, you can use our website (www.SeniorCarePlus.com) or call Customer Service at 775-982-3112 or toll-free at 888-775-7003 (TTY users should call the State Relay Services at 711) Monday through Sunday, 8 am to 8 pm (10/15-2/14) and Monday through Friday, 8 am to 8 pm (2/15-10/14).Customer Services also has free language interpreter services available for non-English speakers.

The Senior Care Plus Pharmacy and Therapeutics Committee consists of healthcare professionals with expertise in prescription medications and other therapies. The P&T committee meets periodically to review our formulary and approve certain Formulary changes. Prior to removing a covered Part D drug from our formulary, or making any change in the preferred or tiered cost-sharing status of a covered Part D drug, Senior Care Plus must either: Provide direct written notice to affected enrollees at least 60 days prior to the date the change becomes effective; or at the time an affected enrollee requests a refill of the Part D drug, provide such enrollee with a 60 day supply of the Part D drug under the same terms as previously allowed and written notice of the formulary change.

Listing of formulary changes since the beginning of the year are provided in the
Notice of Formulary Changes - View Changes  

To request a prescription drug coverage determination regarding a prior authorization, quantity limit exception, step therapy exception, formulary exception, or a tiering exception please review the following material:
Prescription Drug Initial Coverage Determination and Appeal Language - View Guidance
Prescription Drug Initial Coverage Determination Request - View Form

Prior Authorization Criteria -
View Criteria
Step Therapy Criteria - View Criteria
Quantity Limit Criteria - View Criteria

A brief description of low-income premium subsidy and low-income cost-sharing amounts and our Best Available Evidence policy is provided in
Low-Income Subsidy Information - View Information  

A brief description of transition drug policies is provided in the
Transition Drug Information - View Information

A brief description of the medication therapy management is provided in the
edication Therapy Management Program Information - View Information
This is not considered a benefit.

Material ID: Y0039_2014_SCPWebsite CMS Approved Last Updated 1/6/2014

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Información en español 775-982-3242