Medicare Part D FAQ

Medicare Part D became effective Jan. 1, 2006, as the result of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare Part D is a prescription drug benefit provided by private insurance companies and other providers approved by Medicare and contract with the federal government.

Who qualifies for Teamster Plus Prescription Drug Plans (PDP)?
You are eligible for membership in Teamster Medicare Part D as long as:

You are enrolled by your sponsoring employer/union in our plan
You are a Teamster retiree or spouse or dependent of a Teamster retiree
You are entitled to Medicare Part A and/or you are enrolled in Medicare Part B.

What costs are covered under Teamster Plus Prescription Drug Plans (PDP)?
Teamster Plus Prescription Drug Plans (PDP) covers costs for drugs that are available only by prescription, approved by the Federal Drug Administration (FDA), used and sold in the United States, used for a medically accepted condition, and are on the Formulary.

All Teamster Plus Prescription Drug Plans (PDP) plans are required to cover generic and brand name prescription drugs, biological products, vaccines, insulin, necessary syringes, needles, alcohol swabs, and gauze. Teamster Plus Prescription Drug Plans (PDP) does not cover drugs for anorexia, weight loss/gain, ED, fertility, and cold/cough relief. Also not covered are barbiturates, benzodiazepines, prescription vitamins, over-the-counter (OTC) medications, and cosmetics.

Where can I find general information about Medicare prescription drug coverage?
Please call Medicare at 1-800-MEDICARE/1-800-633-4227 (TTY/TDD users: 1-877-486-2048), available 24/7. Or, visit www.medicare.gov

Where can I get my prescriptions filled?
Teamster Plus Prescription Drug Plans (PDP) utilizes a network of participating pharmacies. You must use a network pharmacy to receive plan benefits. To find out if your pharmacy is in the network, call us toll-free at 1-866-412-7445 (TTY/TDD users: 1-866-524-4174), 8 am to 8 pm in your local time zone or click on Pharmacy Locator.

What is a network pharmacy?
A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Teamster Plus Prescription Drug Plans (PDP) prescription drug coverage. In most cases, your prescriptions are covered under our plan only if you fill them at a network pharmacy or through our mail order service. We will honor prescriptions at a nonnetwork pharmacy under certain circumstances.

How do I fill a prescription at a network pharmacy?
You must show your Teamster Plus Prescription Drug Plans (PDP) Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription rather than paying just your copayment. If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call Customer Service.

How do I fill a prescription through Teamster Plus Prescription Drug Plans (PDP)'s mail order pharmacy service?
To get order forms and information about filling your prescriptions by mail, please click on Useful Forms. Please note that you must use Teamster Plus Prescription Drug Plans (PDP)'s mail order service. Prescription drugs that you get through any other mail order service are not covered.

Use the Teamster Plus Prescription Drug Plans (PDP) mail order service to fill prescriptions for 'maintenance drugs'. These are drugs that you take on a regular basis for a chronic or long-term medical condition. Our formulary indicates which drugs we consider to be maintenance drugs. To use our mail order service, ask your doctor to write a new prescription for up to a 90-day supply of medication, plus refills as appropriate.

What if I need to fill a prescription while I am traveling, and I am away from the plan's service area?
If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. You may be able to order your prescription drugs ahead of time through our mail order pharmacy service.

Note: We cannot pay for any prescriptions that are filled by pharmacies outside the United States and territories, even for a medical emergency.

What will I pay if I go to an out-of-network pharmacy for one of the reasons listed above?
You will pay the full cost, rather than paying just your copayment when you fill your prescription at an out-of-network pharmacy. You can ask us to reimburse you for our share of the cost by submitting a claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription.

When you go to a network pharmacy your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy because of the reasons listed above, the pharmacy may not submit the claim directly to us, and you will have to pay the full cost of your prescription. When you return home, submit the Direct Member Reimbursement Form (Useful Forms) and your receipt to the following address: Prescription Solutions, P.O. Box 29046, Hot Springs, AR 71903. Upon receipt, we will make an initial coverage determination on the claim. Please refer to your Evidence of Coverage or call Customer Service for more information on initial coverage determinations.

How does healthcare reform affect Medicare Part D?
The Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D enrollees who have reached the Initial Coverage Limit and are not already receiving Extra Help. A 50% discount based on your out-of-pocket cost or the negotiated manufacturer price (excluding the dispensing fee) whichever is less, will be available on most brand name drugs. Your Summary of Benefits explains your cost sharing for your plan and how the Medicare Coverage Gap Discount Program will impact your cost sharing. If you already receive Extra Help, this discount program does not apply to you.

If you have any questions about the availability of discounts for the drugs you are taking, or about the Medicare Coverage Gap Discount Program, please contact customer service.

Where can I find more information about Teamster Plus Prescription Drug Plans (PDP)?
Refer to your Evidence of Coverage and other plan materials to find additional information about your Teamster Plus Prescription Drug Plans (PDP) prescription drug coverage. You can also contact Teamster Plus Prescription Drug Plans (PDP) Customer Service at 1-866-412-7445 (TTY/TDD users: 1-866-524-4174), 8:00am to 8:00pm in your local time zone.

How do I end my membership in your plan?
Usually, to end your membership in our Plan, you simply enroll in another Medicare Part D plan during an enrollment period. If you do not want to keep our Plan, you can choose to enroll in another Medicare prescription drug plan or to drop your Medicare prescription drug coverage. However, you should check with your group benefits administrator first.

If you would like to switch from our plan to:

Another Medicare prescription drug plan
Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from our Plan when your new plan's coverage begins.
A Medicare Advantage Plan
Enroll in the Medicare Advantage plan. With most Medicare Advantage plans, you will automatically be disenrolled from our plan when your new plan's coverage begins. However, if you choose a Private Fee-For-Service plan without Part D drug coverage, a Medicare Medical Savings Account plan, or a Medicare Cost Plan, you can enroll in that new plan and keep our plan for your drug coverage. If you want to leave our plan, you can either enroll in another Medicare prescription drug plan or contact your employer/union or our Teamster Plus Prescription Drug Plans (PDP) Customer Service, or Medicare, and ask to be disenrolled. Call us toll-free: 1-866-412-7445. Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4174. Or, contact Medicare and ask to be disenrolled: 1-800-MEDICARE (1-800-633-4227). TTY users: 1-877-486-2048.
Original Medicare without a separate Medicare prescription drug plan
Contact your employer/union Benefits Administrator or our Teamster Plus Prescription Drug Plans (PDP) Customer Service and ask to be disenrolled from the Plan. Call us toll-free: 1-866-412-7445. Hearing-impaired callers using TTY/TDD equipment call toll-free: 1-866-524-4174. Or, contact Medicare and ask to be disenrolled: 1-800-MEDICARE (1-800-633-4227). TTY users: 1-877-486-2048.

updated 10/01/11