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AbilityCare Prescription Drug Benefit

Medicare Part D Prescription Drug Benefit

When you are enrolled in AbilityCare, South Country Health Alliance provides Medicare Part D (prescription drug) coverage. The AbilityCare Part D List of Covered Drugs (also known as the formulary) is shown on this page in different formats. You may search our online formulary to see what is covered (click here to go to the online formulary). You may also download and view or print a copy of the List of Covered Drugs from the Member Materials box on the right side of this page. Sometimes the List of Covered Drugs changes, so call Member Services if you have questions. If your current prescription drugs are not on the list of covered drugs or are limited in some way, SCHA has a Part D Transition Policy (pdf) which explains what happens in certain situations. AbilityCare’s pharmacy network equals or exceeds CMS requirements for pharmacy access in your area. You can find network pharmacies here in two ways: You may download and view or print a copy of the pharmacy section from the Provider and Pharmacy Directory, located on the Provider Directory page. You may also search the online listing to find a pharmacy near you (click here to go the pharmacy search). If you have Medicare, and depending on your income and institutional status, your prescription drug copay will be:

  • For generic drugs: $0, $1.30, or $3.60
  • For brand name drugs: $0, $3.90, or $8.95

For more information on prescription drug coverage, see your Evidence of Coverage. For Part D Exceptions and Appeals Information, visit our Part D Coverage Determination, Appeals, and Exceptions page.

You must use network pharmacies to access your prescription drug benefit, except under certain circumstances. For more information about this, out-of-network coverage, or if your pharmacy leaves the network, see your Evidence of Coverage. Free printed copies of both the List of Covered Drugs and the Provider and Pharmacy Directory are available upon request by calling Member Services.

 

Medicare's Extra Help Program
Medication Therapy Management (MTM)

 

H5703_3773, Approved

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AbilityCare Member Materials
Name
Enrollment FormPDF
Evidence of CoveragePDF
Annual Notice of ChangesPDF
Summary of BenefitsPDF
Pre-Enrollment ChecklistPDF
List of Covered Drugs (Formulary)PDF
Formulary UpdatesPDF
Provider and Pharmacy DirectoryWeb Page
Medicare Star RatingsPDF
LIS Premium Summary ChartPDF
CMS Best Available Evidence CoverageWeb Page
Covered Diabetic Testing SuppliesPDF
A list of AbilityCare Member materials for download for 2020.