Part D Plan Information
Formulary
Click here to see the comprehensive list of prescription drugs covered on the RMHP Standard, Gold and Plus Part D plans.
Click here to see the comprehensive list of prescription drugs covered on the RMHP Essential Rx PDP plan.
The formulary will also explain the copayment or tier level applicable to the drugs you take (for example: generic, preferred brand, non-preferred brand).
RMHP is required to provide 60-day notice regarding removal or change in the tier level applicable to the drugs on the formulary.
Click here to see RMHP’s formulary change notice.
Click here for the Rocky Mountain Health Plan's Prescription Drug Transition Process.
Participating Pharmacies
Click here to see the Pharmacy Directory, the list of contracting pharmacies that you must use for the RMHP Part D drug benefits.
RMHP has contracts with pharmacies that equals or exceeds CMS requirements for pharmacy access in your area. This document will give you more information about the number of pharmacies in the network, and the pharmacy addresses and types of pharmacies that you may utilize to access your prescription drugs through RMHP Part D plans. Covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the plan’s service area where there is no network pharmacy. In addition to paying the copayments/coinsurances listed below, you will be required to pay the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions.
Extra Help
If you have qualified for additional assistance for your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in RMHP Part D Plan, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay. If you are not receiving this additional assistance, you should contact 1-800-MEDICARE (TTY/TDD users should call 877-486-2048) 24 hours/day, 7 days/week, your State Medicaid Office, or the Social Security Administration at 1-800-772-1213 or on the toll free TTY/TDD number, 1-800-325-0778, between 7 a.m. and 7 pm. Monday through Friday, to see if you might qualify.
Click here to see the Premium Summary Table for those receiving extra help:
Additional Information Available to Beneficiaries
There is additional information available to Medicare beneficiaries about RMHP Medicare Part D Plans:
Click here for the Member evidence of coverage document. (coming soon)
This document provides more detailed information about:
- Conditions associated with receipt or use of benefits
- Out-of-network coverage
- Grievance, coverage determinations, appeals procedures, and exceptions process (See Section 12 of the EOC)
- Quality assurance policies and procedures, including medication therapy management, and drug and/or utilization management
- Potential for contract termination
- Beneficiaries’ and plan’s rights and responsibilities upon disenrollment
To obtain an aggregate number of the Plan's grievances, appeals, and exceptions please call Rocky Mountain Customer Service.
Click here to see the copy of the Preathorization Form physicians use to preauthorize your prescription drugs.
Click here to see the Medicare Prescription Drug Determination Request Form:
Click here to see the copy of the Formulary Exception Request Form used by physicians to send supporting statements for exception requests:
RMHP offers Medication Therapy Management Programs to our Members. Medication Therapy Management Programs (MTM) are available to all Medicare Part D Members who meet the limited criteria and are designed to assist Members in optimizing their medication therapies. This program combines the services of RMHP clinical pharmacists and Colorado registered pharmacists with medication data from Rocky Mountain Health Plans and is provided at NO CHARGE to our Members. MTM services are voluntary and the program is not considered a benefit of your plan. Contact RMHP Customer Service for additional information.
Appeals
Call Rocky Mountain Health Plans Customer Service for information on how to file or check on the status of an appeal at 800-346-4643 8:00 a.m. to 5:00 p.m. Mountain Time, Monday through Friday. Part D benefit questions: 8:00 a.m. to 8:00 p.m., Mountain Time, seven days a week (except Thanksgiving & Christmas). If you are hearing impaired and use TTY equipment, call 800-704-6370, toll free.
If you wish to authorize another individual to make requests or present information to us on your behalf, you must complete the Appointment of Representation Form and send it to PO Box 10600, Grand Junction, CO 81502
Click here for RMHP’s privacy notice.
Information is current as of 12/20/07, please call to confirm that you have the most up-to-date information about our Medicare plans. CMS 122007 S5860 HO602 1037003 MC150WEB MEDIGAP-2007-AD-MC150WEB-0807