Medicare Part D Prescription Drug Benefit
2010 AbilityCare Member Materials
- 2010 Certificate of Coverage (WITHOUT Medicare) (.pdf)
- 2010 Certificate of Coverage (WITH Medicare) (.pdf)
- 2010 Summary of Benefits (.pdf)
- 2010 Member Guide (.pdf)
- LIS Summary Table (.pdf)
- 2010 Provider Directory (.pdf)
- 2010 Comprehensive Formulary (.pdf)
- Formulary Drug Changes from 2009 to 2010, effective 1/1/2010
- Primary Care Clinic Network Listing (.pdf)
- CMS Best Available Evidence Coverage (web)
Search Online: AbilityCare WITHOUT Medicare
Search Online: AbilityCare WITH Medicare
Health Promotions Vouchers
Note: PDF format requires Adobe Reader® software. If you don't have it, download it for free here.
For people with Medicare, AbilityCare includes Medicare Part D (prescription drug) coverage.
You can see the AbilityCare Medicare Part D formulary (list of covered drugs) on this page. You may search online by checking the drug list to see what is covered. You may also download and view or print a copy of the Comprehensive Formulary from the Member Materials box on the right side of this page. Sometimes the formulary changes, so call Member Services if you have questions.
Q: What if my current prescription drugs are not on the formulary or are limited on the formulary?
A: SCHA has a General Transition Notice (pdf) which explains what happens in these situations.
Part D: Exceptions and Appeals Information
Click here to go to MyPrime.com for information, forms, and instructions regarding:
- Formulary Exceptions: Used to request coverage for a drug not on the formulary (not covered) or to request a tier exception
- Prior Authorizations: Required on some medications before your drug will be covered
- Step Therapy: Requires the previous use of one or more drugs before coverage of a different drug is provided
- Appeals: If you or your doctor does not agree with the outcome of the initial coverage determination - you or your doctor may appeal the decision by having your doctor request a re-determination
Center for Medicare & Medicaid Services Best Available Evidence Coverage