First United American Group Prescription Drug Plan (PDP) FAQ

Medicare Part D became effective Jan. 1, 2006, as the result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare Part D is a prescription drug benefit provided by private insurance companies and other providers approved by Medicare who contract with the federal government.

Who is eligible for the First United American Group Prescription Drug Plan (PDP)?
You are eligible for membership in our plan as long as your employer/union has enrolled you in our plan and you are entitled to Medicare Part A and/or you are enrolled in Medicare Part B. You are entitled to this program regardless of your health history or the prescription drugs you take. If you have limited income and resources, you may qualify for Extra Help. Contact the Social Security Administration at 1-800-772-1213 to see if you qualify.

What costs are covered under Medicare Part D?
Medicare Part D covers costs for drugs that are: available only by prescription, approved by the Federal Drug Administration (FDA), used and sold in the United States, and used for a medically accepted condition.

All Medicare Part D plans are required to cover generic and brand name prescription drugs, biological products, vaccines, insulin, necessary syringes, needles, alcohol swabs, and gauze. Medicare Part D does not cover every drug. For example, drugs for anorexia, weight loss / gain, erectile dysfunction, fertility, and cold/cough relief are not covered. It also does not cover barbiturates, benzodiazepines, prescription vitamins, over-the-counter (OTC) medications, and cosmetics. Medicare can exclude a drug from coverage at any time during the enrollment.

Where can I find general information about Medicare prescription drug coverage?
Please call Medicare at 1-800-MEDICARE/1-800-633-4227 (TTY/TDD users: 1-877-486-2048), available 24/7. Or, visit www.medicare.gov.

How does healthcare reform affect Medicare Part D?
The Medicare Coverage Gap Discount Program will provide manufacturer discounts on brand name drugs to Part D enrollees who have reached the Initial Coverage Limit and are not already receiving Extra Help. A 50% discount based on your out-of-pocket cost or the negotiated manufacturer price (excluding the dispensing fee) whichever is less, will be available on most brand name drugs. Your Summary of Benefits explains your cost sharing for your plan and how the Medicare Coverage Gap Discount Program will impact your cost sharing. If you already receive Extra Help, this discount program does not apply to you.

If you have any questions about the availability of discounts for the drugs you are taking, or about the Medicare Coverage Gap Discount Program, please contact customer service.

Where can I get my prescriptions filled?
First United American Group Prescription Drug Plan (PDP) utilizes a network of preferred (participating) pharmacies. You must use a network pharmacy to fill your prescription. To find out if your pharmacy is in the network, contact us or click on Find a Pharmacy.

What is a network pharmacy?
A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by First United American Group Prescription Drug Plan (PDP) prescription drug coverage. In most cases, your prescriptions are covered under our plan only if you fill them at a network pharmacy or through our mail order service. We will honor prescriptions at a non-network pharmacy under certain circumstances.

How do I fill a prescription at a network pharmacy?
You must show your First United American Group Prescription Drug Plan (PDP) Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription rather than paying just your copayment. If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call Customer Service.

How do I fill a prescription through First United American Group Prescription Drug Plan’s (PDP) mail order pharmacy service?
To get order forms and information about filling your prescriptions by mail, please visit www.medco.com or call Medco Customer Service at 1-800-4REFILL/1-800-473-3455 (TTY/TDD users: 1-800-716-3231). Please note that you must use First United American Group Prescription Drug Plan's (PDP) mail order service (click on Useful Forms link). Prescription drugs that you get through any other mail order service are not covered.

Use the First United American Group Prescription Drug Plan (PDP) mail order service to fill prescriptions for ‘maintenance drugs.’ These are drugs that you take on a regular basis for a chronic or long-term medical condition. Our formulary indicates which drugs we consider to be maintenance drugs. To use our mail order service, ask your doctor to write a new prescription for up to a 90-day supply of medication, plus refills as appropriate.

What if I need to fill a prescription while I am traveling?
If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. You may also be able to order your prescription drugs ahead of time through our mail-order pharmacy service.

Note: We cannot pay for any prescriptions that are filled by pharmacies outside the United States and territories, even for a medical emergency.

What will I pay if I go to an out-of-network pharmacy?
You will pay the full cost, rather than paying just your copayment when you fill your prescription at an out-of-network pharmacy. You can ask us to reimburse you for our share of the cost by submitting a claim form. If you go to an out-of-network pharmacy, you may be responsible for paying 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 prescription.

When you go to a network pharmacy your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy, the pharmacy may not submit the claim directly to us, and you will have to pay the full cost of your prescription. When you return home, simply submit your claim and your receipt to the following address: Medco Health Solutions, Inc., P.O. Box 14711, Lexington, KY 40512. Upon receipt, we will make an initial coverage determination on the claim. Please refer to your Evidence of Coverage or call Customer Service for more information on initial coverage determinations.

Where can I find more information about the First United American Group Prescription Drug Plan (PDP)?
Refer to your Evidence of Coverage and other plan materials to find additional information about your First United American Group Prescription Drug Plan (PDP) prescription drug coverage. You can also Contact Us.