The Health Plan/THP Medicare Rx Information
With over 58,000 pharmacies in our network, SecureCareHMO & SecureChoicePPO are offered by The Health Plan/THP. Coverage is provided through a Medicare Advantage organization or a Medicare Prescription Drug Plan Sponsor with a Medicare contract. Benefits, limitiations, service areas and premiums are subject to change on January 1 of each year.
Important Information
Following is important information concerning your SecureCareHMO and SecureChoicePPO Part D prescription plan:
- Drug Utilization Management
The Health Plan/THP utilizes drug management programs to ensure certain drugs are used in the most effective manner and also to help control plan drug costs. These may include: Prior Authorization, Quantity Limits, Step Therapy, and Generic Substitution. We also conduct drug utilization reviews to make sure members are getting safe and appropriate care. We conduct drug utilization reviews each time you fill a prescription and on a regular basis by reviewing our records. - Medication Therapy Management
Members who have several chronic diseases, take a lot of different medications, and have an expensive monthly drug bill may need assistance in managing their medication usage. These members are offered counseling with our clinical pharmacists in order to optimize their medication therapy.To be eligible for medication therapy management a member must have three of the following chronic diseases: Osteoporosis, Heart Failure, Diabetes, Dyslipidemia, or Hypertension. The member must also have a minimum of eight Part D medications filled and must likely incur annual costs of at least $3,000 for Part D drugs. A letter will be sent to eligible members notifying them of the program.
For more information please contact our Customer Service in the Ohio Valley or Mountaineer Region at 1.877.847.7907 (TTY/TDD: 1.800.622.3925) or the HomeTown Region at 1.800.426.9013 (TTY/TDD: 1.877.236.2291).
Please Note: the medication therapy management program is not considered a benefit.
- Potential for Contract Termination
The Health Plan/THP has contracts with Medicare and our provider networks to provide contracted services to eligible members in our service area. If any contract between Medicare or the provider organizations is altered for any reason, you will be notified of the change in a timely manner in accordance with Medicare regulations and provided with information on steps you should take to continue to receive Medicare services. - Prior Authorization
SecureCareHMO and SecureChoicePPO requires your or your physician to get prior authorization for certain drugs. This means that you will need to get approval from SecureCareHMO or SecureChoicePPO before you fill your prescription. Learn more about which drugs may require prior authorization. - Quantity Limits
For certain drugs, SecureCareHMO and SecureChoicePPO limits the amount of drugs that they will cover. Learn more about which drugs may be subject to quantity limits. - Step Therapy
In some cases, SecureCareHMO and SecureChoicePPO requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. Learn more information about Step Therapy.
If you would like information about the aggregate number of grievances, appeals, and exceptions filed with The Health Plan/THP Insurance Co., please call our Customer Service in the Ohio Valley or Mountaineer Region at 1.877.847.7907 (TTY/TDD: 1.800.622.3925) or in the HomeTown Region at 1.800.426.9013 (TTY/TDD: 1.877.236.2291).
