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Soundpath Health Prescription Drug Coverage

Prescription drugs are an important consideration when making decisions about your medical coverage. Part D is the Medicare prescription drug program. The program is managed by private companies approved by CMS and is a voluntary benefit. However, penalties may apply if you don't sign up for Medicare Part D at the time you are initially eligible. Monthly premiums vary by plan and product selected.

Soundpath Health has five benefit plans that provide coverage for Part D in 2014. We have a comprehensive formulary (list of covered drugs) that describes the coverage for our plans. Below is a chart that outlines the coverage for each benefit plan. You may click on the Formulary button on the side to see the drug tier, copayment and any limitations for each of the covered drugs listed in the Formulary. *Soundpath Health members received their Abridged Formularies with their ANOCs. Please click here for more information.

 

Network Pharmacies

When your plan includes Part D prescription coverage, you can use any of the pharmacies in the extensive pharmacy network to have your covered prescriptions filled.Our network includes over 750 retail pharmacies so, chances are, you can find several in your neighborhood to choose from. Plus we offer a prescription drug mail-order service that can provide a convenient way to receive your long-term prescription drugs. Soundpath Health has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. To locate a pharmacy, call us, or click here to review the 2014 Provider/Pharmacy Directory.

 

 

2014 Drug
Coverage Plans

2014 Plans

Sound+Rx

Pinnacle+Rx

Charter+Rx

Apex+Rx

Peak+Rx

Deductible
$310
Tier 1 - $6 
Copay
$310
Tier 1 - $6 
Copay
$0
$0
$310
Tier 1 - $6 
Copay
Tier 1
Preferred Generic
Drug Copay
$6 $6 $6 $6 $6
Tier 2
Non-Preferred
Generic Drug
Copay
$18 $18 $18 $18 $18
Tier 3
Preferred Brand
Drug Copay
$36 $36 $36 $36 $36
Tier 4
Non-Preferred
Brand Drug
Copay
$60 $60 $60 $60 $60
Tier 5
Specialty Drug
Coinsurance
25% 25% 33% 33% 25%
Coverage Gap
$4,550
No Gap 
Coverage
$4,550
No Gap 
Coverage
$4,550
Tier 1 - $6 
Copay
$4,550
Tier 1 - $6 
Copay
Tier 2 - $18
$4,550
No Gap 
Coverage 

Important Information
Regarding Part D Coverage

Download Important Information For Part D Coverage

2014 Soundpath Health Transition Policy Download
2014 Comprehensive Formulary Download
2014 Comprehensive Formulary in Spanish DOWNLOAD
Future Formulary Changes
A list of all formulary changes, updated monthly.
  View Page  
2014 Prior Authorization Requirements DoWNLOAD
2014 Step Therapy Requirements Download
2014 Summary of Benefits (SB) Download
2014 Summary of Benefits (SB) in Spanish Download
Soundpath Health Part D Coverage Determination Request Form DOWNLOAD
Soundpath Health ONLINE Part D Coverage Determination Requests through MedImpact  VIEW PAGE  
Grievances & Appeals form
If a beneficiary would like to appoint a person to file a grievance, request a coverage determination or exception, or request an appeal on his or her behalf, the beneficiary and the person accepting the appointment must fill out this form (or a written equivalent) and submit it with the request.
  View Page  
CMS Best Available Evidence Policy  VIEW PAGE  
CMS Coverage Determinations and Exceptions Forms and Tools  VIEW PAGE  

Note: * Eligible beneficiaries must use network pharmacies to access their prescription drug benefit (except under non-routine circumstances). Quantity limitations and restrictions may apply. These programs are not considered a benefit.

If you have problems viewing the downloaded information, make sure you have Adobe Reader Installed Click here to download Adobe Reader. Please note, you will be directed to a non-Medicare website.

Page Last Updated: July 31, 2014