Prescription Drug Plan
Physicians Choice Advantage + Rx also offers access to a wide variety of prescriptions eliminating the need to buy a separate Part D prescription drug plan. Here you will find the necessary information for you to make informed choices on how to utilize your prescription drug benefit and the tools to help you locate a pharmacy near you or use our convenient mail-order service to have prescriptions delivered straight to your door - no need to fight traffic or wait in lines at the pharmacy.
If you are dealing with a condition such as diabetes, high blood pressure, high cholesterol, hypertension, congestive heart failure or other heart condition, we know you need to pay close attention to your medications and treatments. We have treatment plans specifically designed to fit your needs, and you will feel more confident than ever that your medications are managed right the first time.
For a summary of a specific topic please click the appropriate link from the list below or simply scroll down the page:
Find a Pharmacy
Physicians Choice Advantage + Rx has contracts with pharmacies that equal or exceed CMS pharmacy access requirements in your area. As of September, 2008 there are over 59,000 pharmacies in the Physicians Choice Advantage + Rx network, which is a nation wide network.
The 2008 Pharmacy Directory or the 2009 Pharmacy Directory and Pharmacy Locator is current as of October 2008, but please remember that a pharmacy's status is subject to change. Physicians Choice Advantage + Rx has a very broad nation wide network but for purposes of space we have only listed the retail pharmacies in the State of Oregon. A pharmacy's listing in this directory does not guarantee that the pharmacy is still contracted with the Physicians Choice Advantage + Rx network. It is a good idea to call the pharmacy to confirm if they are still in the Physicians Choice Advantage + Rx plan network before you receive services. The current contracting status of any pharmacy may be obtained by calling our Customer Service department at 503-584-4210 or toll free 1-888-462-2708, or for the hearing and speech impaired TTY line 1-800-471-7944, 7 days a week, from 8:00 am to 8:00 pm.
Click here to find a particular pharmacy using the Pharmacy Locator.
Click here to access the full Physicians Choice Advantage + Rx pharmacy listings in the 2008 Pharmacy Directory. or the 2009 Pharmacy Directory
Back to topCost Sharing
Physicians Choice Advantage + Rx will pay part of the costs for your covered drugs and you will pay part. As a member of Physicians Choice Advantage + Rx you pay $67.00 premium and $0.00 deductible in 2008 and a $69.00 premium and a $0.00 deductible in 2009. You will also have low copays.
The amount you pay depends on which drug tier your drug is in under our plan. You can find out which drug tier your drug is in by looking in the Formulary that begins on page 7.
Initial Coverage
During the 2008 plan year you pay the following until your total yearly drug costs (the amount you pay plus the amount we pay) reach $2,510:
- Generics Drugs = $5.00 copay for a 30 day supply.
- Brand Drugs = $20.00 copay for a 30 day supply.
- Specialty Drugs = 25% coinsurance for a 30 day supply
During the 2009 plan year you pay the following until your total yearly drug costs (the amount you pay plus the amount we pay) reach $2,700:
- Generics Drugs = $5.00 copay for a 30 day supply.
- Brand Drugs = $20.00 copay for a 30 day supply.
- Specialty Drugs = 25% coinsurance for a 30 day supply
Coverage Gap
During the 2008 plan year, after your total yearly drug costs reach $2,510, you pay 100% until your yearly out-of-pocket drug costs reach $4,050.
During the 2009 plan year, after your total yearly drug costs reach $2,700, you pay 100% until your yearly out-of-pocket drug costs reach $4,350.
Catastrophic Coverage
During the 2008 plan year, after your yearly out-of-pocket drug costs reach $4,050, you pay the greater of a $2.25 copay for generic (including brand drugs treated as generic) and $5.60 copay for all other drugs, or a 5% coinsurance.
During the 2009 plan year, after your yearly out-of-pocket drug costs reach $4,350, you pay the greater of a $2.45 copay for generic (including brand drugs treated as generic) and $6.00 copay for all other drugs, or a 5% coinsurance.
For more information about your Part D cost sharing as a member of Physicians Choice Advantage + Rx please contact Customer Service.
Back to topFormulary
Physicians Choice Advantage + Rx may add or remove drugs from our Formulary (our list of covered drugs) during the year. To get updated information about the drugs covered by Physicians Choice Advantage + Rx, please review our Formulary or call Customer Service at 1-888-462-2708 8:00 a.m. to 8 p.m., 7 days a week. TTY users should call 1-800-471-7944.
If we remove drugs from our formulary, (or) 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 members who take the drug that it will be removed at least 60 days before the date that 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.
There are two ways to find your drug within the Formulary:
Medical Condition: The list of drugs in the Formulary begins on page 7. The drugs in this Formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, 'Cardiovascular Agents'. If you know what your drug is used for, look for the category name in the list that begins on page 7. Then look under the category name for your drug.
Alphabetical Listing: If you are not sure what category to look under, you should look for your drug in the Index that begins at the end of the document. The Index provides an alphabetical list of all of the drugs included in this document. Both brand-name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list.
Click here to see a full listing of Physicians Choice Advantage + Rx covered drugs on the Formulary.
To obtain more information about the Formulary please contact Customer Service.
Back to topMail Order Services
Physicians Choice Advantage + Rx is excited to be able to provide you the ease and convenience of a mail order prescription drug benefit. If you are taking long term maintenance medications you may be able to take advantage of this benefit. Your physician can help you determine if your medications are appropriate to be filled through mail order. Please note that Physicians Choice Advantage + Rx uses an exclusive mail order pharmacy through CVS Caremark. Prescription drugs that you get through any other mail order service are not covered.
To access the mail order benefit and get your medications via mail order please download and fill out the Mail Order Form. For more information or assistance regarding the Mail Order Form you can contact the Customer Service Department at 503-584-4210 or toll free 1-888-462-2708, or for the hearing and speech impaired TTY line 1-800-471-7944, 7 days a week, from 8:00 am to 8:00 pm.
You are not required to use mail order prescription drug services to obtain an extended supply of maintenance medications. Instead, you have the option of using a retail pharmacy in Physicians Choice Advantage + Rx's network to obtain a maintenance supply of medications. Please look in the Evidence of Coverage (available in January 2008) or call our Customer Service Department at 503-584-4210 or toll free 1-888-462-2708, or for the hearing and speech impaired TTY line 1-800-471-7944, 7 days a week, from 8:00 am to 8:00 pm.
If you choose to use the CVS Caremark mail order pharmacy for your maintenance drugs, please allow 10 to 14 days from the date you mail your order for delivery of your medicine.
If we anticipate a delay in shipment of more than 10 days, for any reason, we will call you within 24 hours of receiving and logging the prescription. We will consult with you to help you decide whether to wait for the medication, cancel the mail order, or fill the prescription at a local pharmacy.
Back to topMedication Therapy Management Program
Physicians Choice Advantage + Rx has a special program to help beneficiaries who have several chronic conditions and take many medications for those conditions. You may be contacted by a Nurse Case Manager from Physicians Choice Advantage + Rx. The case manager may ask you questions regarding your conditions and the medications you take and determine if Physicians Choice Advantage + Rx might be able to assist you in any way. Our goal is to help you to be as healthy as possible. If you would like to find out more information or see if you qualify for the program, please call Customer Service.
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