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ABOUT MEDICARE PRESCRIPTION DRUG PLAN COVERAGE
VibrantRx is the Employer Prescription Drug Plan (PDP) for State of Arizona Medicare-eligible retirees and Medicare-eligible dependents.
All prescriptions must be filled in an in-Network pharmacy by presenting your VibrantRx insurance card.
- If you elect any Benefit Options Medical Plan, you pay a combined medical/pharmacy premium and will be automatically enrolled in VibrantRx.
- Medicare Part C or Part D
- If you enroll in either a Medicare Part C or Part D plan other than VibrantRx you will not be eligible for Benefit Options medical coverage.
- Part D Income Related Monthly Adjustment Amount
- If you are assessed a Part D-Income Related Monthly Adjustment Amount (IRMAA), you will be notified by the Social Security Administration.
- You will be responsible for paying this extra amount.
- You will be billed directly by Medicare.
- Do NOT pay the Part D-IRMAA extra amount to VibrantRx.
VIBRANT Rx WEBSITE
- Drug Search – Find information on over 17,000 medications.
- Benefits Highlights – View your current copayment amounts and other pharmacy benefit considerations.
- Formulary Lookup – Determine drug coverage and obtain a cost estimate for a selected medication.
- Pharmacy Locator – Find a participating pharmacy near your location.
- PersonalHealth Rx® – Print your prescription history for a physician visit or tax reporting.
- Health & Wellness – Valuable health tips plus information on diseases and health conditions.
VibrantRx | 844-826-3451 | myvibrantrx.com/stateofaz | Rx BIN: 015574 | Rx PCN: ASPROD1
The formulary is the list of medications chosen by a committee of doctors and pharmacists to help maximize the value of your prescription benefit. Generic and brand-name medications are available at a lower cost.
Generally, your formulary will not change during the year except for cases in which you can save additional money or to ensure your safety. If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we will notify affected members of the change at least 60 days before the change becomes effective. Some drugs may have additional requirements or limits on coverage.
- Specialty Drugs - are included in the EGWP Formulary document, listed as Tier 4. Specialty for EGWP is classified based on the monthly drug cost.
- Employer Group Waiver Plan (EGWP) Wrap Benefit - Drugs excluded from Part D coverage may be covered under the additional wrap coverage provided by Benefit Options. The wrap drugs are listed by drug name in the Formulary.
GUIDELINES AND LIMITS
- Prior Authorization - Our plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from our plan before you fill your prescriptions. If you don’t get approval, our plan may not cover the drug.
- Quantity Limits - For certain drugs, our plan limits the amount of the drug that our plan will cover. For example, our plan provides 30 tablets per 30 days per prescription for simvastatin. This may be in addition to a standard one-month or three-month supply.
- Step Therapy - In some cases, our plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, our plan may not cover Drug B unless you try Drug A first. If Drug A does not work for you, our plan will then cover Drug B.
CONTROLLING YOUR COSTS
MAIL ORDER PHARMACY
Save money with mail order - receive a three-month supply for the price of a two-month supply. Vibrant Rx Mail Order Pharmacy Order Form
CHOICE 90 Rx
Save time and money at the pharmacy - in just one visit, pick up a full three-month supply for the price of two-and-a-half copays.
iRx DISCOUNT PROGRAM
- The iRx Program™ may be able to provide a discount on certain brand and generic medications that are not covered by your ADOA pharmacy drug plan.
- Present your medical ID card at any participating pharmacy, along with your prescription for the medication.
- Savings are applied automatically when the item prescribed qualifies for a discount.
TOBACCO CESSATION PROGRAM
Smoking cessation help is available at no cost to you. All help services are free and available in English and Spanish. To take the first step toward quitting, call 844-866-3727.
COPAYS - VIBRANT Rx MEDICARE PRESCRIPTION DRUG PLAN
|Drug Tier Number / Name||Retail|
(up to 31-day supply)
(up to 90-day supply)
|Choice90 Rx Extended supply at retail|
(up to 90-day supply)
|Tier 1: Generic||$15||$30||$37.50|
|Tier 2: Preferred Brand||$40||$80||$100|
|Tier 3: Non-Preferred Brand||$60||$120||$150|
|Tier 4: Specialty - Over $6701||$60||not available||not available|
|1total medication cost|| || || |