The Retail Maintenance Pharmacy Network for the Quality Care Health Plan, Health Alliance Illinois, Humana-Winnebago and HealthLink OAP will be changing significantly effective 09/20/2010.* The Retail Maintenance Program permits a member to purchase a 90-day supply of maintenance medication for two co-payments at a retail maintenance network pharmacy. Further information along with the list of participating pharmacies (which continues to be updated as pharmacies join the network) is available on CMS' website. Members may also contact their pharmacy to determine whether or not they intend to join the network. If a Retail Maintenance Pharmacy is not available in your area, you may consider using the Mail Order Pharmacy (see information below) as a cost effective alternative.
*Health Alliance HMO as well as HMO Illinois, Humana Health Plan and PersonalCare participants are not affected.
Non-Maintenance Medication (60-day supply or less)
- In-Network Pharmacy** - Retail pharmacies that contract with Medco and accept the co-payment amount for non-maintenance medications
- Out-of-Network Pharmacy - Pharmacies that do not contract with Medco
Maintenance Medication (61-90 day supply)
- The Maintenance Medication Program was developed to provide an enhanced benefit to plan participants who use maintenance medications. Maintenance medication is medication that is taken on a regular basis for conditions such as high blood pressure and high cholesterol. When plan participants use the Maintenance Network for maintenance medications, they will receive a 61-90 day supply of medication (equivalent to 3 fills) for only two co-payments.
- The Maintenance Network is a network of retail pharmacies that contract with Medco to accept the co-payment amount for maintenance medication. Pharmacies in this network may also be an in-network retail pharmacy, not part of the Maintenance Network, as described under the Non-Maintenance Medication section. If a participant uses a retail network pharmacy, only the first two 30-day fills will be covered at the regular co-payment amount. Subsequent fills will be charged double the co-payment rate.
Mail Order Pharmacy
- Both maintenance and non-maintenance medications may be obtained through the mail order process. Please contact Medco at 800-899-2587 or at www.medco.com for order form and further information.
**Note: The In-Network Pharmacy List is not changing.