Are prescriptions Eligible for Sharing?
Prescription medications (Rx) are Eligible for Sharing with limitations.
Members must have Medicare Part D and have their prescriptions initially processed through Medicare in order for prescription costs to be eligible for sharing. All sharing will be secondary to Medicare.
Prescription medication expenses for prescribed drugs that may be dispensed, injected, or administered may be credited toward the annual PRA. Psychotropic medication is not eligible for sharing.
At the pharmacy, Members must present both their Medicare and GraceWell member cards (see Rx information on the card). Members pay 100% of the prescription amount at the pharmacy, and submit eligible expenses in the Member Center. If the Member has Medicare Part D, the amount paid will be applied to the annual PRA.
After the Member’s annual PRA has been met, eligible prescriptions for Members with Medicare Part D will be shared up to $1,200 per Member, per membership year.
Exceptions may be made in the case of medications for cancer and transplant recipients.
More information can be found here.