The prescription drugs your D-SNP covers are shown in a formulary, also called a Drug List. Your formulary shows which Medicare Part D prescription drugs are covered under your Medicare Part D benefits. It also stays updated with any drug restrictions.
Our Medication Therapy Management (MTM) Program is a no cost program that helps our members get the most out of their medication. If you choose to join the MTM program, a pharmacist or other health professional will review all your medications, then talk with you about:
You’ll also get a written summary with next steps if needed.
At Highmark Wholecare we feel that medication coverage goes beyond prescriptions. This is why Over-the-Counter (OTC) benefits have been added to your D-SNP. You’ll get an OTC allowance every three months, offering you four shopping periods a year to buy plan approved items. You can place your orders:
Note, For 2024, the amount you’ll get every three months depends on your D-SNP plan. For 2025, this program will no longer be offered. Instead, over-the-counter benefits will be included in the my flex card program.
Your D-SNP prescription drug benefits includes both Medicare Part D and Medicaid prescription drug coverage. When you doctor writes a prescription, your drug coverage offers:
Remember to show your membership card each time you visit your pharmacy.
Your D-SNP prescription drug benefits follow rules and coverage limits, called step therapy, for medically administered Medicare Part B drugs. In some instances, like injectables or biologics, step therapy has you try a preferred drug first before non-preferred drugs are covered.
Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Medicare Ombudsman Website
Best Available Evidence
Y0037_1359_M_2025
Last Updated: Oct 1, 2024
