How do I find out if my drug is covered?

How do I find a pharmacy?

Will the preferred drug list (formulary) change?

Yes, please check this web site for updates as the preferred drug list (formulary) may change from month to month.

Do you offer generic drugs?

Community Choice Advantage covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Will I have a co-pay for my prescription drugs?

How do I find out if I am eligible to receive additional help to pay for my prescription drug costs?

You may be able to get extra help to pay for your prescription drug premium and costs. To see if you qualify for getting extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week);
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and
  7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or:
• Your State Medicaid Office.

What is a network pharmacy?

What is Step Therapy?

In Step Therapy, certain drugs are put into groups to help your doctor decide which drugs to prescribe. The steps in the process are:

• Step 1: Front-line drugs are generic drugs proven safe, effective and affordable. These drugs should be tried first because they can provide the same health benefit as more expensive drugs, at a lower cost.
• Step 2: Back-up drugs are lower-cost brand-name drugs such as those you see advertised on TV.
• Step 3: Back-up drugs that are higher-cost brand drugs. Back-up drugs may be used when lower cost alternatives do not meet a members needs.

How will the Transition Period requirement be handled?

As a Part D plan, Community Choice Michigan allows a one time 34 day, prescription of a non-formulary drug to members who are new to the plan.

Do you require prior authorization?

Are the doctors in your network aware of your prescription drug benefits?

What if I have to use an out-of-network pharmacy?

Can the formulary change?

We may add or remove drugs from the formulary during the year. Changes in the formulary may affect which drugs are covered and how much you will pay when filling your prescription. If were move drugs from the formulary, or add prior authorizations, quantity limits and/or step therapy restrictions on a drug, and you are taking the drug affected by the change, we will notify you of the change at least 60 days before the date that the change becomes effective. If we don’t notify you of the change in advance, you will get a 60-day supply of the drug when you request a refill of the drug. However, if a drug is removed from our formulary because the drug has been recalled from the market, we will not give 60 days notice before removing the drug from the formulary. Instead, we will remove the drug from our formulary immediately and notify members about the change as soon as possible.

How do I file a grievance or appeal a decision about my prescription drug benefits?

How do I find out about Community Choice Michigan’s Quality Assurance Program?