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Pharmacy Access Statement
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Medi-Pak Rx (PDP) enrollees must use network pharmacies to receive plan benefits, except under emergency care circumstances.
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Enrollment Limitations
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Medicare beneficiaries may enroll in a plan only during specific times of the year. For more information, see Enrollment Guidelines.
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Eligibility
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You must be entitled to Medicare Part A or enrolled in Medicare Part B and live in the service area (Arkansas).
Medicare beneficiaries enrolled in an MA PFFS plan that includes Medicare prescription drugs or any MA coordinated care (HMO or PPO) plan will be automatically disenrolled from the HMO, PPO or MA PFFS plan if they enroll in a PDP. Medicare beneficiaries enrolled in a Private Fee-for-Service (PFFS) plan that does not include Medicare prescription drug coverage, an MA Medical Savings Account (MSA) plan or an 1876 Cost plan may enroll in a PDP and will not be automatically disenrolled from the PFFS, MSA or 1876 Cost plan.
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Benefit and Plan Premium Information
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You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
If a beneficiary decides to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for it to take effect and you will be held responsible for those premiums.
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Availability of Alternative Formats
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Material is available in alternative formats for the visually impaired by calling 1-866-390-3369 (TTY/TDD users should call 1-800-370-5869), 8 a.m. to 8 p.m.,
Monday-Friday.
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Online Enrollment Center
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Medicare beneficiaries may enroll in Medi-Pak Rx (PDP) through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.cms.gov. For more information on Medi-Pak Rx (PDP) call 1-866-390-3369 (TTY/TDD 1-800-370-5869), 8 a.m. to 8 p.m.,
Monday-Friday.
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Medicare Helpline
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People on Medicare may contact 1-800-MEDICARE (1-800-633-4227) (24 hours a day, 7 days a week) and TTY/TDD users should call 1-877-486-2048 for more information about Medicare benefits and services including general information regarding Medicare Prescription Drug Insurance.
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Hours of Operation
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Call us at 1-866-390-3369, 8 a.m. – 8 p.m., Monday-Friday (TTY: 1-800-370-5869).
You may qualify for extra help with your monthly premium and drug costs.
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S5795_Rx_REV Website Submission (12/07/09)
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