Presbyterian Senior Care (HMO) and Presbyterian MediCare PPO | Summer 2019 | Your Story

www.phs.org/Medicare 7 Five-tier drug plans Most members have a five-tier drug plan with five copayment amounts. See the 2019 Evidence of Coverage Schedule of Benefits for the amount of your copayments. Your out-of-pocket expenses are lowest when you fill prescriptions for Tier 1 (preferred generic) and Tier 2 (generic) drugs. Your copayments are higher for Tier 3 (preferred brand name drugs) and Tier 4 (non-preferred drugs). Tier 5 drugs are specialty pharmaceuticals. Specialty pharmaceuticals are medications for people who have serious, chronic, or rare health conditions. These medications are high cost, often require special storage and handling, and need to be taken on a very strict schedule. These prescriptions may be available only at certain pharmacies. For more information consult your Pharmacy Directory or call the PCSC. Your provider may first have to obtain a prior authorization before these drugs are covered. Will mail service save youmoney? Depending on your prescription drug plan and on the medication you take, you may save money and time using the mail order service. Check your 2019 Evidence of Coverage for information about copayments if you decide to use the mail order option. Contact PCSC at the number on your member ID card for the mail-order pharmacy contact information. You can also find the Mail Order Prescription Form at www.phs.org/ Medicare . Select “For Members,” then from the Resources list select “Forms, Plan Information, Policies.” Under “Prescription Drugs” you will find a mail order prescription form that you may print. If you prefer to conduct your own search, go to www.phs.org/mypres . Log in to myPRES, select “Access MyPharmacy” to find information about your health plan benefits, pharmacy locations, and more. Presbyterian’s Quality Improvement Program Presbyterian Centennial Care wants to give quality care and services to our members. We have a Quality Improvement Program (QI Program) that reviews the care and services you receive. The QI Program includes: ● ● Annual goals, processes, and activities ● ● Quality and safety of clinical care review ● ● Quality of service work ● ● Member experience activities As part of our QI Program, we seek health plan accreditation by the National Committee for Quality Assurance (NCQA). NCQA is a private, 501(c)(3), not- for-profit organization that works to improve healthcare quality. Accredited health plans must meet more than 51 standards. The NCQA standards focus on: ● ● Quality improvement and management ● ● Population health management ● ● Utilization management ● ● Credentialing of healthcare practitioners and providers ● ● Member rights and responsibilities ● ● Member engagement and satisfaction All Presbyterian Health Plan products were successfully accredited in 2018. Please contact the Presbyterian Customer Service Center at (505) 923-5200 or 1-888-977-2333 to learn more about the QI Program. PCSC is available for members October 1–March 31, seven days a week from 8 a.m. to 8 p.m. and April 1– September 30, Monday through Friday (except holidays) from 8 a.m. to 8 p.m. Members can reach PCSC at the following numbers: Presbyterian Senior Care (HMO/HMO-POS) and Presbyterian MediCare PPO: ● ● (505) 923-6060 or 1-800-797-5343 . TTY users: 711 Presbyterian Dual Plus (HMO D-SNP): ● ● (505) 923-7675 or 1-855-465-7737 . TTY users: 711 . For answers about your prescription benefits, the PCSC is here for you.