Frequently asked questions for providers

How will the merger affect enrollment in our stores?

The difference for this annual election period is that we will offer Medicare Advantage products with integrated prescription drug coverage (MAPD) in addition to prescription drug-only plans, which will give your patients a wider range of options from which to choose.

With the complexities in the new MAPD products we offer, it’s a great time to work with an in-store agent. As part of Universal American, we now have access to a large, highly trained team of agents. These agents also understand our pharmacist-centered business model and will work closely with you and your patients. Also, MAPD applications are required to be taken by a licensed agent.

What about mail order?

The acquisition does not change our position on mail order. As always, plans administered by MemberHealth will not use mail order. Universal American values and supports our approach of elevating the relationship between patient and pharmacist and understands that community pharmacy—not mail order—is at the heart of this approach.

What about 90-day supplies?

Our 90-day supply policy will continue. In fact, in 2008 it will be expanded so that enrollees both in PDP and MAPD plans will be able to take advantage of this cost-saving benefit.

Will MemberHealth’s processing or reimbursement change?

No. The way you submit claims and receive reimbursement or contact the Pharmacy Technical Center will remain the same. How is Prescription Pathways associated with MemberHealth?

Prescription Pathways is a pre-existing, contracted PDP administered by Universal American and CVS/Caremark that will continue in 2008. While this plan includes a mail order option, it is not associated in any way with MemberHealth or the CCRx plans. Mail order will continue to be excluded from all CCRx Part D programs. Why is there suddenly such a push for Medicare Advantage plans with integrated prescription drug coverage (MAPDs)?

MemberHealth and Universal American teamed up to create a new product line for 2008 that will offer a wider variety of coverage options for Medicare-eligible seniors. Because these plans offer coverage greater than traditional Medicare, in addition to CCRx prescription drug benefits, many of your patients may be able to save money by being enrolled in an MAPD . These plans also feature one premium, one ID card and one customer service number—all of which can simplify things in the complex world of Medicare.

Are Private-Fee-for-Service MAPD plans good for everyone—including dual-eligible beneficiaries?

In general, PFFS plans are not a good fit for dual-eligible beneficiaries. On the other hand, some MAPD plans (for example our HMO products) provide more coverage and may be an excellent choice. However, the HMO products are not available in all regions, and the best fit varies by individual.

Bottom line: different plans are best for different people. This is why it’s particularly helpful to have an agent in your store. Universal American’s agents know the details of the MAPD plans and how they impact enrollees. They are trained to identify the specific needs of individuals and match them with the most appropriate, cost-effective product. Are you going to promote MAPD products over PDP products?

Our plan is to promote MAPD and PDP products equally, but as appropriate for your patients. We want your patients to choose a plan that fits their needs best—regardless if it’s an MAPD, PDP, HMO or even a plan with one of our competitors. We do feel, however, that with our wide range of coverage options, your patients will comfortably be able to select a plan that meets their needs. Who do I call if I have more questions about MAPDs and Today’s OptionsŪ powered by CCRxSM?

If you would like an educational guide to use at the pharmacy counter when talking about MAPD plans with your patients (and if you live in one of the states in which MAPDs are offered and you did not already receive an MAPD kit), contact the Pharmacy Technical Center at 1-866-684-5395.