Prescription Drug Information (Part D)
Abrazo Advantage Plus (HMO SNP)With 850 pharmacies, Abrazo Advantage Health Plan's pharmacy network equals or exceeds CMS requirements for pharmacy access in your area.
AA Plus Abridged Formulary Spanish
Click Here to Find a Doctor/Pharmacy
Click Here to Request Coverage Determination
Click Here for our Pharmacy Transition Plan
Out of Network Coverage
We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. We recommend that you fill all prescriptions prior to traveling out of the area so that you have an adequate supply as you could pay more for any drugs you get from
an out-of-network pharmacy.
Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy and quantity limitations and restrictions may apply. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:
- Emergency situations
- When you are out of the service area for up to but no more than 6 months
If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than paying your normal share of the cost) when you fill your prescription. We will reimburse you at our contracted rate which is our share of the cost. The difference will be your responsibility.
In these situations, please call Member Services first at (888) 864-1114 or TTY/TDD (800) 489-1472 from 8 am to 8 pm, seven days a week, to see if there is a network pharmacy nearby.
Medication Therapy Management (MTM)
AAHP has programs that help our members manage their Part D medications in special situations. For example, some members have several complex medical conditions and may need to take many drugs at the same time, or they could have very high drug costs. A team of pharmacists and doctors developed the MTM program for to help these members with their care.
MTM can help make sure that our members are using the drugs that work best to treat their medical conditions and help us to identify possible medication errors. The program is voluntary and free to members. If you meet the criteria for the MTM, we will automatically enroll you in the program and send you information. If you decide not to participate, please notify us and we will withdraw your participation in the program.
Quality Assurance
AAHP has systems in place for all of our members to make sure that they are getting safe and appropriate care. Our programs include real-time and historic review of prescription claims to reduce medications errors and adverse drug interactions. Our reviews are especially important for members who have more than one doctor who prescribe their medications, use more than one drug, or have more than one pharmacy.
Utilization Management (Prior Authorization Requirement)
AAHP had a team of doctors and pharmacists create tools to help us provide quality coverage to our members. The tools include but are not limited to: prior authorization criteria, clinical edits, quantity limits and step therapy. Some examples include:
Age Limits: Some drugs require a prior authorization if your age does not meet the manufacturer, FDA, or clinical recommendations.
Quantity Limits: For certain drugs, AAHP limits the amount of the drug we will cover per prescription or for a defined period of time.
Prior Authorization: We require you to get prior authorization for certain drugs. (You may need prior authorization for drugs that are on the formulary or drugs that are not on the formulary and were approved for coverage through our exceptions process.) This means that you will need to get approval before you fill your prescriptions. If you don't get approval, AAHP may not cover the drug.
Generic Substitution: When there is a generic version of a brand-name drug available, our network pharmacies will automatically give you the generic version, unless your doctor has told us that you must take the brand-name drug. If the brand-name drug is approved, you may be responsible for a higher co-pay and/or the difference in cost between the brand and generic medications.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.
H5985_502-2011 CMS Approved 03022012