view text: smaller | LARGER
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, $1.25, or $3.40
  • For brand name drugs: $0, $3.80, or $8.50

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

Search Tools

Find a Provider

 

Find a Pharmacy

 

Find a Drug
AbilityCare Member Materials
Name20192020
Evidence of Coverage2019 PDF2020 PDF
Annual Notice of Changes 2019 PDF 2020 PDF
Summary of Benefits2019 PDF2020 PDF
Pre-Enrollment Checklist2019 PDF2020 PDF
List of Covered Drugs (Formulary)2019 PDF2020 PDF
Formulary UpdatesNovember 2019N/A
Provider and Pharmacy DirectoryWeb Page
Medicare Star Ratings2019 PDF2020 PDF
LIS Premium Summary Chart2019 PDF2020 PDF
CMS Best Available Evidence CoverageWeb Page
Covered Diabetic Testing Supplies2019 PDF2020 PDF