Medication Benefits

Your medication benefits cover prescriptions, over-the-counter items and more. Here’s a guide to help you learn about how Highmark Wholecare Dual Eligible Special Needs Program (D-SNP) medication benefits work.

Formularies

The prescription drugs your D-SNP covers are shown in a formulary, also called a Drug List. Your formulary shows which Medicare Part D prescription drugs are covered under your Medicare Part D benefits. It also stays updated with any drug restrictions.

LOOK AT MY FORMULARY

Medication Therapy Management Program

Our Medication Therapy Management (MTM) Program is a no cost program that helps our members get the most out of their medication. If you choose to join the MTM program, a pharmacist or other health professional will review all your medications, then talk with you about:

• What you’re taking
• How much your drugs cost
• Over-the-counter medications
• Any problems or questions you have

You’ll also get a written summary with next steps if needed.

GET MTM DETAILS

Quality Assurance

Quality Assurance and Related Policies: Keeping Your Medicine Safe

We want you to be safe when you take your medicine. That's why we have quality assurance programs and policies to check your prescriptions. Here's what our quality assurance includes:

• Pharmacy Rules: The pharmacies in our network must follow the rules related to screening your medicines.
• Checks When You Get Your Medicine: When you get a prescription filled, the pharmacist checks to make sure it's safe for you. They look for things like:
  
  • If you are taking two medicines that do the same thing.
  • If the medicine is not right for someone your age or gender.
  • If you are taking too much or not enough medicine.
  • If the medicine could cause problems with other medicines you take.
  • If you are taking the right dose of medicine for the right amount of time.
  • If you are allergic to the medicine.
  • If the medicine is being used the wrong way.
• Looking Back at Your Prescriptions: We also look at all the prescriptions filled to see if there are any patterns of problems. This helps us find ways to make things safer for everyone.