Pharmacy & Part D

Verda Health Plan of Texas gives you special Medicare Advantage plans. These plans include something called Medicare Part D, which helps you pay for medicine you get from the pharmacy. It also helps with vaccines and some things not covered by other parts of Medicare, like Part A or Part B.

To find out more about the medicine coverage in Part D, check out the Summary of Benefits for our plan. It tells you about costs like premiums, copayments, coinsurance, and deductibles. For a full explanation of all the benefits, take a look at the Evidence of Coverage.

Important Information About Vaccine Costs: Our plan takes care of the cost for most Part D vaccines at no cost to you. Call Member Experience if you want to know more.

Important Information About Insulin Costs: You’ll never have to pay more than $35 for a month’s supply of any insulin our plan covers, no matter how much it usually costs.

Getting Assistance from Medicare: If you need help with the cost of your medicine, it’s good to know that there might be other choices with even lower costs because of changes in the Medicare Part D program. You can reach out to Medicare at 1-800-MEDICARE (1-800-633-4227) anytime, day or night, for help comparing your options. TTY users can call 1-877-486-2048.

More Ways to Get Help: If you need more information, you can call Member Experience at 1-888-256-5123, TTY: 711.  Hours are 8:00 a.m. to 8:00 p.m., 7 days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.

Prescription drugs are available through our mail-order service, BirdiRx, as well as through our retail network pharmacies. Consider using mail order for your long-term (maintenance) medications (such as high blood pressure medications). Retail network pharmacies may be more appropriate for short-term prescriptions (such as antibiotics).

Before some medications can be covered, we need to make sure they are covered. If your doctor wants you to take a certain medication that is not covered, they have to ask for permission first by filling out a special form.

Sometimes, Verda Health Plan of Texas might ask you to try certain medications first to help with your health issue before we pay for a different one. This is called step therapy, and it’s a way to carefully manage how prescription drugs are used.

If you need help understanding your coverage or if you want to appeal a decision, you can ask someone to act on your behalf. You can choose another person to be your representative by filling out a special form called the Appointment of Representative form. Both you and the person helping you need to sign the form.  Contact Member Experience once the form is completed.

A coverage decision is when Verda Health Plan of Texas decides what they will help pay for with your medical services or medication. When we make an initial decision about Part D drugs, it’s called a “coverage determination.”

For more information or to request a Coverage Determination, click here.

In case Verda Health Plan of Texas declines your request to cover or pay for a prescription drug, you have the option to request a redetermination (appeal) of their decision.

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

Verda Health Plan of Texas offers a complimentary voluntary program for members dealing with multiple medical conditions, taking numerous prescription drugs, and facing high drug costs. If you meet the criteria, you can access this program at no additional cost.

For additional information, click here.

This policy outlines the steps taken by Verda Health Plan of Texas and its pharmacy benefit manager (PBM) to create and manage the Medicare Transition Program.

For more information, click here.

We perform reviews of medication usage for our members to ensure they receive safe and suitable care. These assessments are particularly crucial for members with multiple providers prescribing their medications.

If we identify a potential issue with your medication usage, we will collaborate with your healthcare provider to address and rectify the concern.

More information coming soon.