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Providence Health Plan is a health plan with a Medicare contract. - page 27 / 32





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PRESCRIPTION DRUGS (CONTINUED FROM PAGE 15) DRUGS COVERED UNDER MEDICARE PART B Some Part B drugs may require authorization. You pay 10% of the cost for Part B-covered drugs. Contact plan for details. The following outpatient prescription drugs may be covered under Medicare Part B. This may include, but is not limited to, the following types of drugs. Injectable Drugs: Most injectable drugs administered incident to a physician’s service, (medications administered in your providers office) for example, chemotherapy regimens. Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility. Some Oral Cancer Drugs: If the same drug is available in injectable form. Oral Anti-Nausea Drugs: If you are part of an anti-cancer chemotherapeutic regimen. Erythropoietin (Epoetin Alfa or Epogen®): By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia. Inhalation and infusion: Drugs provided through DME. Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision. Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare. Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia.

PRESCRIPTION DRUGS (CONTINUED FROM PAGE 15) PREFERRED NETWORK PHARMACIES (NETWORK DIFFERENTIAL): Preferred pharmacies and Participating pharmacies are pharmacies in the Providence Medicare Advantage Plans network where Providence Medicare Advantage Plans has negotiated a lower price for covered prescription drugs. However, you may pay more for a 90-day supply at a participating pharmacy than you would pay at a preferred pharmacy. If you purchase a 90-day supply at a participating pharmacy, a charge in addition to your copayment or coinsurance will be assessed. This charge is the negotiated price difference between preferred and participating reimbursement rates. If you purchase a 90-day supply at a preferred pharmacy no additional charge will be applied. You will always be charged the lowest copayment or coinsurance amount by using a preferred pharmacy. You may go to either of these types of pharmacies to receive your covered prescription drugs.

USING YOUR PROVIDENCE MEDICARE ADVANTAGE PLANS IDENTIFICATION CARD AT YOUR PHARMACY When filling prescriptions at your pharmacy make sure that you use your Providence Medicare Advantage Plans Identification Card. Ask the pharmacy to process the prescription claim to us. This is the best way to make sure that your prescription out-of-pocket expenses are tracked. Please remember that you will never pay more than what the drug costs.

PRESCRIPTION DRUGS (CONTINUED FROM PAGE 15) DRUGS COVERED UNDER MEDICARE PART D - FREE FIRST FILL The prescription drugs listed below are eligible for a Free First Fill. This allows you to get a free supply the first time you fill one of these generic alternatives/equivalents.


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