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Provider Notice issued 11/25/09
To: Providers of Pharmacy Services
Date: November 25, 2009
Re: Important 2010 Illinois Cares Rx Changes
The purpose of this notice is to inform participating pharmacies of changes in the Illinois Cares Rx (ICRx) Program and Coordinating Medicare Part D Plans, effective January 1, 2010.
Stand-Alone Prescription Drug Plans (PDPs)
United Health Rx Basic will no longer be offered in 2010, and AARP Medicare Rx Preferred will no longer be an ICRx coordinating plan. AARP Medicare Rx Saver Plan (S5921-081) will be the coordinating United PDP for 2010. ICRx members currently enrolled in AARP Medicare Rx Preferred or United Health Rx Basic will be automatically enrolled in AARP Medicare Rx Saver for 2010. Humana PDP Standard will no longer be offered in 2010. Humana Value (S5884-107) will be the coordinating Humana PDP for 2010. ICRx members currently enrolled in Humana PDP Standard will be automatically enrolled in Humana Value for 2010.
The remaining PDPs that coordinated in 2009 will continue to coordinate in 2010. Those PDPs are First Health Part D Premier (S5768-042), SilverScript Value (S5601-034), and Wellcare Classic (S5967-154).
Medicare Advantage (MA) Plans
The following companies will continue to offer MA plans that coordinate with ICRx for 2010: Essence Healthcare, Erickson Advantage, Group Health Plan, Health Alliance, HealthSpring, Humana, PersonalCare, SecureHorizons by United, and WellCare.
A complete listing of coordinating PDPs and MA plans can be viewed on the Illinios Cares Rx Web site.
Benefit Changes
Effective January 1, 2010, all Medicare-eligible ICRx members will receive the comprehensive ICRx Plus benefit. Current Medicare-eligible ICRx Basic members will automatically be enrolled in the Plus benefit. For members not eligible for Medicare, ICRx will continue to be divided into ICRx Plus and ICRx Basic. There are no benefit structure changes for non-Medicare members.
2010 Co-Payments and Cost-Sharing
Medicare-eligible Members:
$2.50 generics
$6.30 preferred brand name drugs
$15 non-preferred and specialty drugs
Once $2,830 in drug benefits has been paid on the member’s behalf, the member is responsible for 20% of the cost of the prescription, plus applicable co-pay.
Non-Medicare Members:
$2.50 for generics drugs
$6.30 for brand-name drugs
Once $1,750 in drug benefits has been paid on the member’s behalf, the member is responsible for 20% of the cost of the prescription, plus applicable co-pay.
Questions or concerns regarding this notice should be directed to a pharmacy billing consultant at 1-877-782-5565 Option 7.
Theresa A. Eagleson, Administrator
Division of Medical Programs