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These medicines are prescribed by your health care provider to help keep you healthy, or treat you when you are sick. Last Update: Wednesday, April 17, 2019 9:52:25 AM. You will receive notice when necessary. If you don't have your plan membership card with you when you fill your prescription, ask the pharmacy to call the plan to get the information. This site contains links to other internet sites. You can search by typing part of the generic (chemical) or brand (trade) names. Formulary medications are Food and Drug Administration (FDA) approved and have been chosen for their reported medical effectiveness and value. Dental; Eye; Your primary care practitioner ; Special tests for women; Copay schedule; Services when you are sick. You must use a network pharmacy to fill your prescription. Supported by certain reference books. Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Keystone 65 Rx HMO or Keystone 65 Rx HMO-POS . Prescription drug benefits Visit your secure account to see prescription drug benefits, check costs or start home delivery. If you need help finding a Keystone First Community HealthChoices dentist, go to Find a Provider and select Dental. Find a pharmacy . Please see Terms of Use and Privacy Notice. You must have a provider (a doctor or other prescriber) write your prescription. History. You won’t have to pay a non-contracted provider … Remember, your drug must be used for a medically accepted indication. Please see Terms of Use and Privacy Notice. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. Exceptions may be possible when used as part of an anti-cancer chemotherapeutic regimen. X-rays. If you get a bill for the services, you may send the bill to Keystone 65 HMO for payment. Find a pharmacy in our network to fill your prescriptions. For information about Keystone First VIP Choice call (833) 243-8258 or visit www.keystonefirstvipchoice.com. Every year, Medicare evaluates plans based on a 5-star rating system. We may or may not agree to waive the restriction for you. This tool will help you find a pharmacy that takes Keystone First in your area. Plain Page Single Section DnD. This site contains links to other Internet sites. Keystone First VIP Choice (HMO D-SNP) is a Local HMO. Keystone First VIP Choice covers both brand name drugs and generic drugs. Coverage by Vista Health Plan, Inc. Copays may apply. A formulary is a comprehensive list of covered drugs selected by a team of health care providers as a part of a quality treatment program. We will pay the non-contracted provider for our share of the bill and will let you know what, if anything, you must pay. Prescription drug frequently asked questions (FAQ). It tells you if there are any rules that restrict coverage for your drugs. You must continue to pay your Medicare Part B premiums, unless otherwise covered by your Pennsylvania Medicaid benefits. Please complete the security check below. As a Keystone First VIP Choice member, your Medicare benefits are covered by an affordable, reliable plan. Keystone HMO Children’s Health Insurance Program (CHIP) Questions about COVID-19 and Keystone HMO CHIP coverage? If you have any questions about this change, please call Member Services at 1-800-521-6860 (TTY 1-800-684-5505). The healthcare provider currently serves over 400,000 residents in the area. The drug list tells you how to find out which drugs are covered under Medicaid. The Keystone First VIP Choice (HMO SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. This formulary is a list of prescription medications that are covered under Vista Health Plan, Inc.'s Medicare Advantage Plan in Pennsylvania. You may qualify for help with a low-income subsidy. * Participants: If you have any problems, call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) 24 hours a day, 7 days a week. This is an important legal … Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Contact info Aetna Better Health No limit Patch, gum, lozenge, Nicotine inhaler and spray Bupropion, Chantix $1 Generic $3 Brand Yes Yes Members can call 1-800-QUIT-NOW (784-8669) 1-866-638-1232 Keystone First Health Plan No limit Patch, gum, lozenge, Chantix, Bupropion Nicotine inhaler and spray: need prior authorization $1 Generic $3 Brand … Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. The plan has a list of covered drugs (formulary). While you are a member of our plan, you must use your plan membership card as well as your Medical Assistance (Medicaid) card to get prescriptions at our network pharmacies. The Keystone First VIP Choice (HMO D-SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Keystone First was founded by the Sisters … If you have questions about your prescription drug coverage: Keystone … All rights reserved. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. You can search by selecting the therapeutic class of the medication you are looking for. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations … The Keystone First VIP Choice (HMO SNP) plan has a $415 drug deductible. This means that you will pay the same amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). Coverage by Vista Health Plan, Inc. Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. However some drugs do not require that the deductible is met before … Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. Keystone First covers medically needed Food and Drug Administration (FDA)-approved medicines. For members over 18 years old, copays may apply to prescriptions. The plan offers national in-network prescription coverage. Pennsylvania Medical Assistance Program Preferred Drug List (PDL) … Enrollment in Keystone First VIP Choice depends on contract renewal. A formulary is a list of drugs, or prescriptions, that a plan covers. Find a pharmacy in your network . When we denied your drug, you received a Notice of Denial of Medicare Prescription Drug Coverage. Independent Licensee of the Blue Cross and Blue Shield Association. A coverage determination is any decision (an approval or denial) that Keystone First VIP Choice makes when you ask for coverage or payment of a drug that you believe Keystone First VIP Choice should provide. Drug lists (formularies) Web Content Viewer - Fixed Context. Some members who are 21 years or older may have prescription coverage too. Keystone First, coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania. Look out for your monthly explanation of pharmacy benefits in the mail. The formulary, pharmacy network, and/or provider network may change at any time. Fillings. Keystone First Community HealthChoices Participants receive these medical benefits: Preventive care/routine care. Cleanings. In addition to the drugs covered by Part D, some prescription drugs are covered for you under your Medicaid benefits. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. It is important to use a network pharmacy because, with few exceptions, you must get your prescriptions filled there if you want our plan to cover the cost. You will receive notice when necessary. If Keystone First VIP Choice denies to cover or pay for a prescription drug, you or your representative can ask us to review our decision. To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact Keystone 65 Customer Service at 1-800-645-3965 or Personal Choice 65 Customer Service at 1-888-718-3333; TTY/TDD users should call 711, 7 days a week, 8 a.m. to 8 p.m.; or you can complete and submit online the Request for Medicare Prescription Drug Coverage Determination or … Details Drug Coverage for the VISTA Health Plan Inc. Keystone First VIP Choice H4227-001 (HMO D-SNP) in Pennsylvania. This plan is available in PA. If there is a restriction on the drug you want to take, you should contact Member Services to learn what you or your provider would need to do to get coverage for the drug. A drug formulary is a list of brand and generic medicines covered by … Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Your drug must be on the plan's list of covered drugs (formulary). The formulary, pharmacy network, and/or provider network may change at any time. Types of restrictions we use for certain drugs: Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. The Keystone 65 Basic Rx (HMO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, plan ratings, accepted doctors and more. Keystone First VIP Choice has a network of pharmacies. This means that the FDA has approved the drug for the diagnosis or condition for which it is being prescribed. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. Request for Redetermination of Medicare Prescription Drug Denial, the prescription drug frequently asked questions (FAQ). All rights reserved. Our plan offers members an extensive provider network of physicians, specialists, pharmacies and hospitals. Some members who are 21 years or older may have prescription coverage too. Extractions (tooth removals). This information is not a complete description of benefits. Every year, Medicare evaluates plans based on a 5-star rating system. What is a coverage determination? The amount you pay for prescription drugs may depend on which pharmacy you use. Keystone First VIP Choice has a network of pharmacies. This plan includes additional Medicare prescription drug (Part-D) coverage. Generic drugs have the same active ingredient as brand name drugs. Want regular information about your pharmacy benefits? You or your primary care provider (PCP) and other prescribers can ask for a coverage determination. Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. Keystone focuses on low-income residents in southeastern Pennsylvania counties including, Bucks, Chester, Delaware, Montgomery, and Philadelphia. Need help paying for your drugs? These reference books are the American Hospital Formulary Service Drug Information (AHFS-DI) and the DRUGDEX® Information System. Keystone First members younger than 21 years old have prescription coverage. The Keystone First VIP Choice (HMO D-SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. It explains how to get coverage for the health care services and prescription drugs you need. Individual Coverage; Employer Coverage; If you have individual coverage from Capital BlueCross or HealthCare.gov. Keystone First is a medical assistance (Medicaid and Medicare) managed care health plan based in southeastern Pennsylvania. We call it the "drug list" for short. If you want us to waive the restriction for you, you will need to use the Coverage Determination process and ask us to make an exception. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. Get 2018 Medicare Advantage information on Keystone First VIP Choice (HMO SNP) from VISTA Health Plan Inc.. Your primary care practitioner; 24/7 nurse call line; Emergency room; Urgent care centers; Pharmacy (prescription) benefits. At Keystone First VIP Choice (HMO SNP), we understand the needs of people who are eligible for both Medicare and Medicaid. It is best to ask a non-contracted provider to bill Keystone 65 HMO first, but if you already paid for the covered services, we will pay you for our share of the cost. Our plan uses different types of restrictions to help our members use drugs in the most effective ways. Health maintenance organizations … As part of Keystone First CHC, you receive the following dental benefits: Exams. For more information on how to fill your prescriptions, see the Keystone First VIP Choice Evidence of Coverage (PDF). Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. A "medically accepted indication" is a use of the drug that is one of the following: Approved by the Food and Drug Administration (FDA). Keystone First members younger than 21 years old have prescription coverage. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Coverage for tobacco treatment services? Please see the Copayment Schedule (PDF) for more information. Keystone 65 Basic Rx (HMO) H3952-056 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Keystone 65 HMO available to residents in Pennsylvania. The formulary is updated at times throughout the year, and the list of drugs may change. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. Drug Formulary: Formulary … As Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan, Keystone First serves Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Keystone First is Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan serving more than 400,000 Medical Assistance recipients in southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Enrollment in Keystone First VIP Choice depends on contract renewal. Keystone 65 Select Rx (HMO) (H3952-051) by Keystone 65 - Chester County, PA. Keystone First CHC gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. Independent Licensee of the Blue Cross and Blue Shield Association. Read our Keystone HMO CHIP COVID-19 Alert, and learn more with the CHIP COVID-19 FAQs.For information on care and resources available for COVID-19, visit our COVID-19 site. Keystone First VIP Choice (HMO SNP) is a Local HMO. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. You may search the Keystone First VIP Choice 2021 Drug Formulary in several ways: You can use the alphabetical list to search by the first letter of your medication. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. For more information, see the prescription drug frequently asked questions (FAQ). This site contains links to other Internet sites. In most cases, your prescriptions are covered only if they are filled at 1 of our network pharmacies. Prescription medicines are prescribed by your health care provider to help keep you healthy, or treat you when you are sick. Fax urgent: 1-855-516-6381 Fax standard: 1-855-516-6380 Call: 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., Monday — Friday Write: Attn: Pharmacy Prior Authorization/Member Prescription Coverage Determination PerformRx 200 Stevens Drive … Last Update: Wednesday, April 17, 2019 9:52:25 AM. Keystone First gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. You do not need a referral to see the dentist. You must continue to pay your Medicare Part B premiums, unless otherwise covered by your Pennsylvania Medicaid benefits. Use this form to send us your appeal. This helps to make sure you have proper drug coverage and limited, if any, cost-sharing responsibility. The Children's Health Insurance Program (CHIP) is a state- and federally-funded health insurance … 1 dental exam and 1 cleaning, per provider/group, every 180 days (6 months). Keystone First Community HealthChoices (CHC) may reimburse you, or pay you back. A network pharmacy is a pharmacy that has agreed to fill covered prescriptions for our plan members. Enrollment in Keystone First VIP Choice depends on contract renewal. If the pharmacy is not able to get your card information, you may have to pay the full cost of the prescription when you pick it up. The formulary has been reviewed and approved by the Centers for Medicare & Medicaid Services (CMS), the agency that administers the Medicare Program. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. This information is not a complete description of benefits. The amount you pay for prescription drugs may depend on which pharmacy you use. In most cases, your prescriptions are covered only if they are filled at 1 of our network pharmacies. Keystone First is not responsible for the content of these sites. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. Keystone First VIP Choice (HMO D-SNP) is a Local HMO. prescription? Generic drugs usually cost less than brand name drugs and are rated by the FDA to be as safe and effective as brand name drugs. Re-cementing of … This is called a redetermination or an appeal. Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. This site contains links to other internet sites. Dental emergencies. This information is not a complete description of benefits. For members over 18 years old, copays may apply to prescriptions. Need help paying for your drugs? Learn all about your benefits and other important plan information with the links below. A formulary is a list of drugs, or prescriptions, that a plan covers. (You can then ask us to reimburse you for our share.). Documents on this page may be updated monthly. How to contact us when you are asking for a coverage decision about your Part D prescription drugs: Submit online or fill out the paper form (PDF). Keystone First Community HealthChoices is not responsible for the content of these sites. Coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association. This is a 4-star Medicare Advantage plan. Find a pharmacy; Find a medicine; Prescription … Healthchoices is not responsible for the health care and prescription drugs are covered only if are... A state- and federally-funded health Insurance program ( CHIP ) is a list of drugs. May have prescription coverage Copay Schedule ; Services when you are looking for emergency situations (! Per provider/group, every 180 days ( 6 months ) 2013-2020 keystone First medically! 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