IMPORTANT: SilverScript included a newsletter titled MemberHealth News in member’s September Explanation of Benefits (EOB), which members would have received in October. This newsletter was included in your EOB statement in error. The content in the newsletter does not apply to your prescription drug plan. In early November, SilverScript mailed a correction letter to impacted members.
View a copy of the Correction Letter
Effective January 1, 2021, the maximum copay per 30-day supply of insulin is $50.
Effective January 1, 2020, increases to the maximum copay will go into effect for brand name and specialty drugs. The maximum copay for a brand name prescription filled with 30-day supply of medication will increase from $50 to $75. Longer supplies of medication will increase accordingly.
Review the “Plan Benefits” tab and “Documents” tab for detailed information about your prescription benefits for the 2020 plan year. To save on your prescription costs, if you are taking a brand name drug, talk with your doctor about generic alternatives.
Generally speaking, vaccinations for Influenza, Pneumonia and Hepatitis B (for intermediate and high risk patients) are covered by your medical plan. Other vaccines (such as for shingles) are covered under Medicare Part D.
Medicare Part D vaccines administered at your physician’s office will not automatically be processed through your SilverScript Insurance. For these vaccines, it will be necessary for you will pay your provider and submit a claim for reimbursement.
In order to be apply for reimbursement, you must submit a SilverScript Claim Form along with an itemized statement from your physician’s office that indicates the cost of the vaccine and administration fee. The Claim Form may be found in the Documents tab above. Please follow all the instructions when completing the Claim Form.
For a current list of covered vaccines and medications, please review the Comprehensive Formulary on the Documents tab above. Please note that formularies are subject to change periodically. If you have questions, or need assistance completing the Claim Form, please contact Member Services toll free at 1-877-321-2597.
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