Pharmacies | Drug Formulary | 2009 Benefits
Pharmacies
If you would like to use our online searchable version to locate available pharmacies click here. To find a Care N’ Care pharmacy near you, view the Provider Directory which lists Care N’ Care pharmacies.
Care N’ Care features more than 60,000 pharmacies in our network.
 59,000 retail pharmacies
4,497 long-term care pharmacies
513 home infusion pharmacies
158 ITU pharmacies
Care N’ Care has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.
Care N’ Care offers mail-order service for prescription drugs. You can find additional information about this service by clicking here.
The Chart Below Illustrates the Difference Between Plan I, Plan II and Plan III Prescription Drug Benefit
| ℞ Benefit |
Care N’ Care Health Plan I |
Care N’ Care Health Plan II |
Care N’ Care Health Plan III |
| |
In-Network Preferred Pharmacy Copayment* |
In-Network Non-Preferred Copayment / or Mail Pharmacy Copayment** |
In-Network Preferred Pharmacy Copayment* |
In-Network Non-Preferred Copayment / or Mail Pharmacy Copayment** |
In-Network Preferred Pharmacy Copayment* |
In-Network Non-Preferred Copayment / or Mail Pharmacy Copayment** |
| Preferred Generic Drugs |
$0 |
$4 / $12 |
$0 |
$5 / $15 |
$2 |
$5 / $15 |
| Preferred Brand Drugs |
$30 |
$30 / $90 |
$33 |
$33 / $99 |
$35 |
$35 / $105 |
| Non-preferred Drugs |
$60 |
$60 / $180 |
$65 |
$65 / $195 |
$65 |
$65 / $195 |
* 30 Day Supply Copay
** 30/90 Day Supply Copay
Drug Formulary
The Care N’ Care formulary is a list of all drugs covered under your plan. The formulary consists of more than 4,000 medications. Additionally, Care N’ Care provides monthly formulary updates to keep information current.
If you would like to use our online searchable version of the formulary, click here.
If you would like to view a PDF version of the formulary, click here. The formulary is current for contract year 2010.
Can the Care N’ Care formulary change?
Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2010 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
The formulary is current as of October 2009.
Can I receive coverage for drugs not on the formulary?
Yes, if you believe you are entitled to payment or benefits on a certain drug, you can request a coverage determination. A coverage determination is a decision made by Care N’ Care regarding payment for a Part D drug or exceptions to our formulary. If your coverage determination is denied, you can Appeal the decision by asking for a redetermination of the original request. Full details on coverage determinations and appeals can be found in the Evidence of Coverage. Read more information regarding coverage determinations, appeals and complaints by viewing the Your Rights page of this website.
What if I’m already taking a drug Care N’ Care doesn’t cover?
During the first 90 days of enrollment, Care N’ Care extends up to a one-month transition supply of medication (unless the prescription is written for fewer days) to members for drugs that are not on our formulary as well as drugs with restrictions or limits. Call the Care N’ Care Prescription Drug Customer Service to find out more.
Drug Formulary Update
Care N’ Care materials are available in alternative formats, please contact customer services for details.
Click here for information regarding Care N’ Care prescription drugs with prior authorization requirements.
Click here for information about Care N' Care prescription drugs with step therapy requirements.
Click here for negative changes to the Care N’ Care formulary.
Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances when they cannot reasonably use network pharmacies.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
- 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213 between 7AM and 7PM, Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
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