Prescription Drug Benefit
Prescription Drug Benefit
West Virginia Senior Advantage (HMO ISNP) provides Medicare Part D prescription drug coverage through its partner Medimpact.
MedImpact is a healthcare and pharmacy benefit management (PBM) company headquartered in San Diego, California.
For your convenience, there is a complete list of all covered drugs in the plan (a comprehensive formulary). Our Online Formulary lists the Part D drugs covered by West Virginia Senior Advantage. Our formulary is designed to cover the drugs most needed to treat the special needs of our members.
If the drug you are taking is not on the list of covered drugs, read your Prescription Drug Transition Policy and Evidence of Coverage to find out what you can do. This includes instructions for both new and current members.
West Virginia Senior Advantage Plan Rating (Part D only). The Star Ratings Program is based off of CMS’ Quality Strategy of optimizing health outcomes by improving quality and transforming the health care system.
For Prescribers & Pharmacies
West Virginia Senior Advantage provides Medicare Part D prescription drug coverage through our partner MedImpact.
MedImpact is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.
For Prescribers:
- MedImpact Pharmacy Helpdesk
- Phone number: (833) 665-5423
- TTY/TDD: 711
- Refer to the Drug List Formulary page for formulary, prior authorization criteria, and step therapy criteria
For Pharmacies:
- MedImpact Pharmacy Helpdesk
- Phone number: (833) 665-5423
- TTY/TDD: 711
- Refer to the Drug List Formulary page for formulary, prior authorization criteria, and step therapy criteria
Member Part D Prescription Drug Benefits
Below is a brief summary of benefits. For a complete list of benefits and other resources, please review your Evidence of Coverage.
How much do I pay?
For Part B drugs such as chemotherapy drugs: 20% of the cost
Other Part B drugs: 20% of the cost
Initial Coverage
After you pay your yearly deductible, you pay 25% of the cost for all drugs covered by this plan until your total yearly drug costs reach $2,000. Total yearly drug costs are the total drug costs paid by both you and our Part D plan.
Catastrophic Coverage
You enter the Catastrophic Coverage Stage when your out-of-pocket costs have reached the $2,000 limit for the calendar year. Once you are in the Catastrophic Coverage Stage, you will stay in this payment stage until the end of the calendar year. During this payment stage, the plan pays the full cost for your covered Part D drugs. You pay nothing.
If you have questions or want to request additional information, please call Member Services at (866) 250-6352. TTY/TDD users should call 711. Live representatives are available 24 hours a day, seven days a week.
How to Request a Coverage Determination
Prescription Utilization Management Step Therapy and Prior Authorization Criteria
West Virginia Senior Advantage Health Plan members can find Part D prescription Step Therapy and Prior Authorization Criteria by clicking on the Online Drug List under the Prescription Drug Benefit topics or at the Online Drug List Link below:
