Frequently Asked Questions

Answers to Drug Coverage (Part D) frequently asked questions by members.

 

• What are Part B drugs?

  Part B drugs are drugs that must be given by a doctor, as well as certain medical equipment, such as diabetic test strips and lancets. Part B drugs are covered under the medical portion of your plan benefits and are not listed in the Medicare Part D Formulary.
  
  Examples of Part B drugs and supplies include:
  
  • Diabetic testing supplies (see "How are diabetic supplies covered?" below), including testing meters, lancets, and OneTouch, Freestyle, and Precision brand test strips. You are allowed 200 test strips for 30 days and 600 test strips for 90 days.
  
  • Inhalation spacers used with inhalers, such as Aerochamber and Optichamber.
  
  • Oral Chemotherapy Agents, such as Xeloda (capecitabine) and Temodar (temozolomide).
  
  
  
  

• How are vaccines covered?

  Most vaccines are covered under your Part D pharmacy benefit. This also includes the cost of giving you the vaccinations. Some vaccines are covered as a preventive service under your Part B medical benefit, such as pneumococcal, rabies, and flu vaccines.
  
  Vaccines can be given at a pharmacy or by your doctor. Many are available at no cost. An office visit co-pay may apply when vaccines are given at your doctor's office.
  
  Always ask your doctor to process your Part D vaccine claims through a service called TransactRx. If your doctor does not process your claim using TransactRx, you will have to pay out-of-pocket for your vaccine and submit the claim to CVS Caremark for reimbursement. MVP will reimburse vaccine claims up to MVP?s allowed amount. If your doctor chooses to charge more than the allowed amount, you will be responsible for paying your co-pay plus the difference between the billed amount and MVP?s allowed amount. If your doctor does not use the TransactRx service, consider getting your vaccination right at the pharmacy, if offered.
  
  
  

• Can I fill prescriptions when I'm away from home?

  You should try to refill any prescriptions before going out of town. Your doctor may need to send the pharmacy a new prescription for an extended supply.
  
  If you're traveling in the U.S. for longer than your current prescription will last, ask your doctor for a new prescription to fill at your travel destination or take your prescription bottle to the pharmacy and ask if they will transfer a refill for you. You can go to any national chain that is in MVP's national pharmacy network, including CVS, Kmart, Rite Aid, Sam's Club, Target, Walgreens, or Walmart. Remember to show your MVP member ID card at the pharmacy.
  
  According to Medicare rules, prescriptions filled outside to of the U.S. are not covered.
  
  
  

• How are diabetic supplies covered?

  Diabetic test strips and blood glucose monitors must be purchased from a preferred manufacturer ? OneTouch, Freestyle or Precision. You will pay a 10% co-insurance for preferred diabetic supplies.
  
  All other test strips and monitors from non-preferred manufacturers are excluded from coverage.
  
  You can ask MVP to cover an excluded monitor or test strip from a non-preferred manufacturer. All requests should include a statement from you prescriber or doctor supporting the request.
  
  
  

 

Last updated: October 2017

Important Information

 

MVP Health Plan, Inc. is an HMO-POS/PPO/MSA organization with a Medicare contract. Enrollment in MVP Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. 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.

Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Medicare beneficiaries may also enroll in Preferred Gold HMO-POS, GoldValue HMO-POS, GoldSecure HMO-POS, Gold PPO, BasiCare PPO, and/or WellSelect PPO through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.