Optional 2017 Prescription Drug Coverage for Medicare Plans

Optional 2017 Prescription Drug Coverage for Medicare Plans

2017 Medicare Part D Plans & Costs

Our 2017 Part D prescription drug plans offer the coverage you want for the prescriptions you need. RMHP offers our Medicare Members:

Placeholder image

Extensive Formulary

We cover a wide variety of medications and work with pharmacies both throughout Colorado and nationwide.
pharmacist in a pharmacy

Local, Knowledgeable Service

At RMHP, our friendly, dedicated team is committed to helping our Members in any way we can.

Looking for 2018 Part D Coverage?

RMHP will no longer offer Medicare Part D plans in 2018.  Visit our 2018 Medicare Part D coverage page for your options for prescription drug coverage for 2018.

2018 Part D Coverage

Formulary

We make understanding the cost of your medications simple. Each drug we cover is assigned a tier. How much you pay at the pharmacy will depend on which tier your medication falls under. If your prescriptions aren't in our Formulary or the quantity is limited, learn how we work with your doctor to find an alternate medication.

Find your prescription

Part D Plan Highlights

Participating Pharmacies

We want filling and picking up your prescriptions to be convenient for you. Whether you want a 30-day supply or a 90-day supply, our large network of pharmacies means there’s sure to be a pharmacy near you. You can also fill your 90-day prescription using our mail order pharmacy service, WellDyneRx.

Find a local pharmacy

Learn more about WellDyneRX

If you’re a resident of a long-term care facility, you can get a 31-day supply of medications from your facility’s pharmacy.

Generally, your prescriptions will need to be filled with one of our partners; however, we know there are times where circumstances won't allow this. If you become ill while traveling, you’re still able to pick up a 30-day supply of your prescription. You will be responsible for your co-payment or coinsurance, as well as the cost difference between the in-network and out-of-network pharmacy. Some restrictions may apply.

Medication Review

Our pharmacists are available to review your current medications and identify potential drug interactions or more cost-effective alternatives. To learn more, please contact us at 970-255-5677 or toll free 877-288-5773, or send us an email.

Email for medication review information

Prior Authorization

There are a handful of medications that you will need to get prior authorization for before we’re able to cover them. Your doctor will need to submit this request to us on your behalf.

Medicare Part D drugs requiring prior authorization - 2017

Medicare Part D prior authorization request

Step Therapy

We do everything we can to keep our coverage affordable. Because of this, we might ask you to try a certain medication for your condition. If that drug isn’t a good fit, we’ll likely be able to cover the other medication.

Medicare Part D drugs requiring Step Therapy - 2017

 

Coverage Determinations

We want you to have access to the forms you and your provider need to manage your prescriptions.

Medicare prescription coverage determination request form
Medicare prescription drug redetermination request form
Non-covered Part D drug request form

If your prescriptions aren't in our Formulary, or we limit the quantity you can have, learn how we work with your doctor to find and transition you to an alternative medication.

2017 Prescription drug transition policy (English)
2017 Prescription drug transition policy (Espanol)
Formulary Change Notice

You'll be notified 60 days prior to any changes made to our Formularies.

If you decide not to enroll in a Part D plan when you are first eligible, you may pay a penalty to join at a later time.

Extra Help for Prescription Drug Costs

Prescriptions can be expensive. That's why there's the Extra Help program available through the government for qualified Medicare beneficiaries. To qualify, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

To see if you qualify or for more information, call Social Security at 800-772-1213 (TTY: 800-325-0778) or visit their website.

Learn more about Extra Help
[Please note: By selecting this link you will be leaving RMHP.org]

2017 Limited Income Subsidy Premiums - Denver Metro  2017 Limited Income Subsidy Premiums - Front Range  2017 Limited Income Subsidy Premiums - Western Slope

Medication Therapy Management

Managing your prescriptions is important. RMHP offers a Medication Therapy Management (MTM) program to assist Members in optimizing effectiveness of prescription drugs. MTM programs are available to all Medicare Part D Members who meet the limited criteria. This no cost program combines the services of RMHP clinical pharmacists and Colorado registered pharmacists. MTM services are voluntary and the program is not considered a benefit of your plan. 

MTM is an annual program requiring qualification each calendar year. Members previously enrolled in the MTM program must meet current year qualifications to carry over to the new year.

To qualify for 2017 MTM services, all of the following must be met:

  • You must be enrolled in a Part D plan
  • You must have three chronic diseases from the list below:
    • Hypertension
    • Congestive Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia/Hyperlipidemia (high blood cholesterol)
    • Chronic Respiratory Disease/Chronic Obstructive Pulmonary Disease (COPD)
    • Bone Disease – Osteoporosis
    • Bone Disease – Osteoarthritis
    • Bone Disease – Rheumatoid Arthritis
    • Coronary Artery Disease (CAD)
    • Alzheimer’s Disease
    • Cerebrovascular Disease (CVD)
    • Cerebrovascular Disease (Stroke)
  • You must be taking five or more Part D covered drugs (any Part D drug qualifies)
  • You must have Part D medication costs likely to exceed Part D costs of $3,919 or greater for the calendar year

If you are Eligible

Part D members are checked monthly for eligibility. Once qualification is met, the member will receive a letter telling them they are eligible for the program and offering a comprehensive medication review (CMR). Once enrolled in the program, a member remains eligible for the entire year regardless of changes to medications, diseases, or medication costs. 

An RMHP pharmacist will contact Members in the program via phone or letter. To conduct a CMR, the pharmacist must speak to the Member, which usually takes 15 to 30 minutes. For targeted medication reviews (TMR), the pharmacist will review medication history but will not usually call the Member. Once the CMR or TMR is finished, a letter with medication recommendations is mailed to the address on record or address given during the review.

For more information about the MTM program, please contact Customer Service at 970-244-7912 or 888-282-1420 (TTY: 711)


Download A Blank Personal Medication List

Medicare Disclaimer

This page was last updated: 10/01/2017.  Please call to confirm you have the most up to date information about our Medicare Cost plans.

H0602_MS_MC2018WEB_1_100117 Pending

Important Disclaimers: RMHP is a Medicare-approved Cost plan.  Enrollment in RMHP depends on contract renewal.  This information is not a complete description of benefits.  Contact the plan for more information.  Limitations, copayments, and restrictions may apply.  Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.  You must continue to pay your Medicare Part B premium.  This information is available for free in other languages.  Please call our customer service number at  888 -282-1420 (TTY dial 711). Hours are 8am - 8pm, 7 days/week, Oct. 1–Feb.14, and 8am - 8pm, M-F, Feb.15–Sept.30. Esta información está disponible gratuitamente en otros idiomas. Por favor llame a la línea de Atención a Clientes, al 888-282-1420 (TTY marque 711). Horario  de 8am - 8pm, 7 días a la semana, del 1 de octubre al 14 de febrero; y de 8am - 8pm, de lunes a viernes, del 15 de febrero al 30 de septiembre.  Other pharmacies, physicians, providers are available in our network.  Medicare beneficiaries may also enroll in RMHP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.  This is not a complete listing of plans available in your service area.  For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.  Medicare evaluates plans based on a 5-star rating system.  Star Ratings are calculated each year and may change from one year to the next.  The formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary.  If you need help finding a network provider, please call 888-282-1420 (TTY 711) or visit www.rmhpMedicare.org to access our online searchable directory. If you would like a provider directory mailed to you, you may call the number above, request one at the website link provided above, or email customer_service@RMHP.org. 

Multi Language Interpreter Service Information (English)
Multi Language Interpreter Service Information (Espanól)

Other Important Information

Let's Find A Medicare Plan That's Right For You