Tag Archives: Prescription

Medicare And Prescription Changes

A lot is happening in the Rx Market this year.  In case you missed it, Aetna has been purchased by CVS health, which has been approved by the DOJ.  As part of this purchase, however, they have to sell Silverscript, the Medicare Rx Program.  This is set to happen around the first of the year, to WellCare.  In the meantime, Silverscripts prices have gone up and Aetna looks much more competitive, and we expect a lot of changes this year.

Walgreens bought Rite Aid and is in the process of consolidating stores and plans.  No word yet on what will happen to Rite Aids’ Envision Rx program, and Walgreens has maintained its deal with AARP.

It is important that Seniors check their prescriptions EVERY year, as this is the time of year when everything changes.  It is too late to change in January when you discover your medication is no longer covered!



Medicare- United American Rx plans now part of Silverscript

Members who receive Medicare Part D benefits through United American (PDP) will see no benefit changes in 2016. All benefits, formulary and the pharmacy network will remain consistent in 2016, yet will be administered and sponsored by SilverScript© Insurance Company.

As a proud member of the CVS Health family of companies, SilverScript (PDP) shares that commitment by offering affordable, high quality coverage to people with Medicare. Unlike other Medicare insurers, Part D prescription drug coverage is our only business and has been since the Part D program began. We have the experience, expertise and focus to deliver high quality, affordable coverage that millions1 of Americans from all walks of life count on everyday for peace of mind.

Oxford now enforcing drug card rules

As you may be aware, in 2014 Oxford small group NY and Conn went to a mandatory generic Rx card, which they called the “Ancillary charge program”.  If you wanted a name brand drug and there was a generic available you were supposed to pay the difference (the ancillary charge) in cost between the name brand and the generic, even if the doctor write DAW (dispense as written).  This was never properly adjudicated by Optum Rx, so members in some instances have been getting name brand drugs for the 3rd Tier copay instead of paying the difference in price between the name brand and the generic.

They have caught the error and are correcting it  now as of Jan 1st, 2016 to adjudicate scripts as they had set it up originally to do.  So now it’s more important than ever to make sure members discuss Rx options with their provider  so they are best prepared for this.  Oxford reports that “Impacted members received {a} letter in December of 2015 – outlining the drug(s) they are currently taking, that will be enforced as part of the program.



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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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