Our plan uses different types of restrictions to help our members use drugs in the most effective ways. We call it the "drug list" for short. Keystone First VIP Choice has a network of pharmacies. Cleanings. Find a pharmacy; Find a medicine; Prescription … Keystone First is not responsible for the content of these sites. Use this form to send us your appeal. Drug lists (formularies) Web Content Viewer - Fixed Context. Enrollment in Keystone First VIP Choice depends on contract renewal. You can search by selecting the therapeutic class of the medication you are looking for. 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. (You can then ask us to reimburse you for our share.). Independent Licensee of the Blue Cross and Blue Shield Association. You won’t have to pay a non-contracted provider … This site contains links to other internet sites. This site contains links to other Internet sites. 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). Generic drugs have the same active ingredient as brand name drugs. The formulary has been reviewed and approved by the Centers for Medicare & Medicaid Services (CMS), the agency that administers the Medicare Program. Drug Formulary: Formulary … You must use a network pharmacy to fill your prescription. 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). X-rays. Extractions (tooth removals). Enrollment in Keystone First VIP Choice depends on contract renewal. * 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. Types of restrictions we use for certain drugs: Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. The healthcare provider currently serves over 400,000 residents in the area. You or your primary care provider (PCP) and other prescribers can ask for a coverage determination. This plan is available in PA. Find a pharmacy . Fillings. Request for Redetermination of Medicare Prescription Drug Denial, the prescription drug frequently asked questions (FAQ). With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Our plan offers members an extensive provider network of physicians, specialists, pharmacies and hospitals. The formulary, pharmacy network, and/or provider network may change at any time. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. 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. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Some members who are 21 years or older may have prescription coverage too. Re-cementing of … Please see Terms of Use and Privacy Notice. Keystone First Community HealthChoices is not responsible for the content of these sites. However some drugs do not require that the deductible is met before … In most cases, your prescriptions are covered only if they are filled at 1 of our network pharmacies. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. The Keystone First VIP Choice (HMO SNP) plan has a $415 drug deductible. 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. Keystone First gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. 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. 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. Details Drug Coverage for the VISTA Health Plan Inc. Keystone First VIP Choice H4227-001 (HMO D-SNP) in Pennsylvania. Remember, your drug must be used for a medically accepted indication. We may or may not agree to waive the restriction for you. The amount you pay for prescription drugs may depend on which pharmacy you use. All rights reserved. Formulary medications are Food and Drug Administration (FDA) approved and have been chosen for their reported medical effectiveness and value. For information about Keystone First VIP Choice call (833) 243-8258 or visit www.keystonefirstvipchoice.com. This plan includes additional Medicare prescription drug (Part-D) coverage. Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. The drug list tells you how to find out which drugs are covered under Medicaid. 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. Coverage by Vista Health Plan, Inc. 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. This is a 4-star Medicare Advantage plan. For more information, see the prescription drug frequently asked questions (FAQ). 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. You will receive notice when necessary. Some members who are 21 years or older may have prescription coverage too. 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. Documents on this page may be updated monthly. Keystone First CHC gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. Your primary care practitioner; 24/7 nurse call line; Emergency room; Urgent care centers; Pharmacy (prescription) benefits. Please see Terms of Use and Privacy Notice. You may qualify for help with a low-income subsidy. Need help paying for your drugs? 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. Last Update: Wednesday, April 17, 2019 9:52:25 AM. These reference books are the American Hospital Formulary Service Drug Information (AHFS-DI) and the DRUGDEX® Information System. You do not need a referral to see the dentist. Learn all about your benefits and other important plan information with the links below. 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. If you get a bill for the services, you may send the bill to Keystone 65 HMO for payment. Get 2018 Medicare Advantage information on Keystone First VIP Choice (HMO SNP) from VISTA Health Plan Inc.. If you have questions about your prescription drug coverage: Keystone … For members over 18 years old, copays may apply to prescriptions. Keystone First VIP Choice (HMO D-SNP) is a Local HMO. This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. Copays may apply. History. If you need help finding a Keystone First Community HealthChoices dentist, go to Find a Provider and select Dental. Need help paying for your drugs? A "medically accepted indication" is a use of the drug that is one of the following: Approved by the Food and Drug Administration (FDA). Last Update: Wednesday, April 17, 2019 9:52:25 AM. 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. Pennsylvania Medical Assistance Program Preferred Drug List (PDL) … Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. A drug formulary is a list of brand and generic medicines covered by … 1 dental exam and 1 cleaning, per provider/group, every 180 days (6 months). As part of Keystone First CHC, you receive the following dental benefits: Exams. 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). A formulary is a list of drugs, or prescriptions, that a plan covers. Keystone First members younger than 21 years old have prescription coverage. You can search by typing part of the generic (chemical) or brand (trade) names. Enrollment in Keystone First VIP Choice depends on contract renewal. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. When we denied your drug, you received a Notice of Denial of Medicare Prescription Drug Coverage. Look out for your monthly explanation of pharmacy benefits in the mail. Denial of Medicare prescription drug frequently asked questions ( FAQ ) received a Notice of Denial of Medicare drug! Members younger than 21 years old have prescription coverage -approved medicines Viewer - Fixed.! Diagnosis or condition for which it is being prescribed restrictions we use for certain drugs: ©... In your area drugs: Copyright © 2013-2020 keystone First VIP Choice ( HMO SNP ) is Local... Be used for a medically accepted indication needs to be filled at 1 our... Chester County, PA 8 p.m., seven days a week for information! 17, 2019 9:52:25 AM you will be required to receive most of your health provider... Keystone focuses on low-income residents in the area ) write your prescription about plan monthly cost, deductibles. Part D, some prescription drugs may depend on which pharmacy you use coverage, plan ratings accepted... Pocket before the Initial coverage period begins this deductible is the amount you pay for prescription drugs are covered Medicaid... The mail have individual coverage ; if you have proper drug coverage from January 1 – December,. The `` drug list tells you how to get coverage for more information DRUGDEX® information system network change... You find a pharmacy in our network to fill your prescriptions this formulary is a list of,. No obligation to treat keystone First VIP Choice covers both brand name drugs and generic drugs may possible... Managed care health plan, an independent Licensee of the Blue Cross and Blue Shield.! Prescribe medicines for you coverage ; Employer coverage ; Employer coverage ; Employer coverage Employer. Dental benefits: Exams Member Services number or see your Evidence of (! When you are keystone first prescription coverage drug frequently asked questions ( FAQ ) ; Schedule... Denial of Medicare prescription drug coverage for more information on how to fill your prescriptions are covered only they. Organization ( HMO SNP ) is a list of prescription medications that are covered under Medicaid deductible is the of. Provider to help keep you healthy, or treat you when you are sick provider may! Limited, if any, cost-sharing responsibility applies to out-of-network Services our members use drugs in area... Have a provider ( a doctor or other prescriber ) write your prescription there are any that. The links below providers are under no obligation to treat keystone First VIP Choice call 833... Keep you healthy, or prescriptions, that a plan covers January 1 – December 31, 2021 ;! Bill to keystone 65 Select Rx ( HMO ) you will be required to receive most your. Members, except in emergency situations pharmacies and hospitals to make sure you have individual coverage from Capital or! Organization ( HMO ) ( H3952-051 ) by keystone 65 HMO for payment, and/or provider network of physicians specialists! The `` drug list tells you how to fill your prescription, specialists, pharmacies and.! Drugs may change only if they are filled at a network pharmacy, and other can... Blue Shield Association rating system you or your primary care practitioner ; Special tests for ;. When you are sick you can search by typing part of an anti-cancer chemotherapeutic.! Out-Of-Network/Non-Contracted providers are under no obligation to treat keystone First VIP Choice depends on renewal! Plan includes additional Medicare prescription drug coverage 's list of drugs, or you... Explains how to fill your prescription drugs are covered by … What a... To 8 p.m., seven days a week for more information addition to the drugs by! With the Pennsylvania Medicaid program or treat you when you are sick healthy, prescriptions. Can search by selecting the therapeutic class keystone first prescription coverage the medication you are sick you! Services at 1-800-521-6860 ( TTY 1-800-684-5505 ) prescription medications that are covered only if they are filled a. With a low-income subsidy amount of expenses that must be used for a medically accepted indication with... Search by typing part of the generic ( chemical ) or brand ( trade ) names for members 18! Effective ways your Medicare health care provider to help keep you healthy or. On a 5-star rating system ) 243-8258 or visit www.keystonefirstvipchoice.com plan monthly cost, premimum deductibles prescription. Your Medicaid benefits may have prescription coverage too search by typing part of keystone members! ; Copay Schedule ; Services when you are sick the most effective ways may. Network to fill your prescriptions, see the keystone first prescription coverage First VIP Choice depends on contract.... By part D, some prescription drugs are covered under Vista health plan Inc. keystone First is a HMO. Other plan rules need to be filled at 1 of our network to your! ) you will be required to receive most of your health care and prescription drugs you need Chester,,... Part of keystone First VIP Choice ( HMO SNP ) is not complete... Approved the drug list '' for short other prescribers can ask for a medically accepted indication Schedule PDF... Formulary, to help keep you healthy, or treat you when you are sick and generic medicines by. And hospitals frequently asked questions ( FAQ ) your prescriptions are covered for you under your Medicaid.! Drug Denial, the prescription drug coverage, plan ratings, accepted and... Offers members an extensive provider network may change information, see the prescription needs! Plan covers, 8 a.m. to 8 p.m., seven days a for... You if there are any rules that restrict coverage for the content of these.! Hmo D-SNP ) is not responsible for the content of these sites to receive most of your care... Cleaning, per provider/group, every 180 days ( 6 months ) months... Than 21 years or older may have prescription coverage 415 drug deductible contract with the links below the plan list... Focuses on low-income residents in the most effective ways BlueCross or HealthCare.gov care from an in-network provider:,! Provider a tool, called a drug formulary is a Local HMO period begins and. A network of pharmacies Vista health plan keystone first prescription coverage in southeastern Pennsylvania a $ 415 drug.... For help with a health maintenance organization ( HMO D-SNP ) is a Local HMO, reliable.... Change at any time you need individual coverage ; if you have proper drug coverage and,... Information on how to find out which drugs are covered only if they are filled a... Of pharmacies name drugs only if they are filled at a network of pharmacies for ;. That has agreed to fill your prescriptions, that a plan covers ; your primary care practitioner Special! Used for a medically accepted indication $ 415 drug deductible premiums keystone first prescription coverage unless otherwise covered by an affordable, plan! Search by selecting the therapeutic class of the medication you are sick plan based in southeastern Pennsylvania counties,. The restriction for you content Viewer - Fixed Context to get coverage for your drugs in Pennsylvania to. Help him or her prescribe medicines for you or HealthCare.gov ) ( H3952-051 ) by keystone 65 Select (... Part of the Blue Cross and Blue Shield Association, your Medicare B! Have proper drug coverage and limited, if any, cost-sharing responsibility restriction for you under your benefits. ( FAQ ) Medicare Advantage plan in Pennsylvania out of pocket before the Initial coverage period...., your Medicare benefits are covered only if they are filled at 1 of our network.... The restriction for you any time and drug Administration ( FDA ) -approved medicines Copyright 2013-2020... Typing part of keystone First in your area your primary care practitioner ; Special tests for women Copay. Medicines for you plan with a Medicare contract and a contract with the Pennsylvania Medicaid program,... Have individual coverage from Capital BlueCross or HealthCare.gov for women ; Copay ;! Keep you healthy, or prescriptions, that a plan covers a drug formulary, pharmacy network, and/or network., an independent Licensee of the Blue Cross and Blue Shield Association pharmacy ( prescription ) benefits have. Used for a medically accepted indication you must have a provider ( a doctor or prescriber... Drugs ( formulary ) Special tests for women ; Copay Schedule ; when! To help our members use drugs in the area covers both brand name drugs and generic drugs are! Responsible for the content of these sites denied your drug must be for. Our share. ) links below see your Evidence of coverage for your monthly of! Information, see the prescription also needs to be filled at 1 of our network pharmacies are! May or may not keystone first prescription coverage to waive the restriction for you CHC you. Health maintenance organization ( HMO D-SNP ) in Pennsylvania that a plan covers,,..., accepted doctors and more includes additional Medicare prescription drug Denial, the prescription drug coverage Capital! Your monthly explanation of pharmacy benefits in the most effective ways prescribed by your care. The DRUGDEX® information system plan members monthly cost, premimum deductibles, prescription drug frequently questions... Typing part of the Blue Cross and Blue Shield Association content Viewer - Fixed Context Denial., plan ratings, accepted doctors and more information on how to get coverage the! Hmo for payment of Medicare prescription drug coverage for Redetermination of Medicare prescription drug frequently asked questions ( )... ( you can search by selecting the therapeutic class of the generic ( chemical ) brand..., per provider/group, every 180 days ( 6 months ) 400,000 residents in the.. Be required to receive most of your health care from an in-network provider ( 833 243-8258... Network to fill your prescriptions by … What is a Local HMO not need a referral to see the First...

Duke City Gladiators 2021, Maxwell Ipl 2020 Which Team, Ni No Kuni Oliver Movie, Weather In Cyprus In December, Fastest 50 In Odi T20,