Medication Benefits

Your medication benefits cover prescription drugs, over-the-counter items, and more. Here’s how Highmark Health Options Duals medication benefits work.

Formulary

The prescription drugs Highmark Health Options Duals 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.

Medication Therapy Management (MTM) Program

Our MTM Program is a no cost program that helps you get the most out of their medication. If you choose to join the MTM Program, a pharmacist or other health care expert 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
• A written summary with next steps, if needed

Over-the-Counter (OTC) Benefit

Some medicine is available without a prescription. Your Highmark Health Options Duals benefit includes an allowance of $208 per month to spend on OTC medicine and medical supplies, like:

• Vitamins
• First aid supplies like bandaids
• Dental products like denture cleaner and toothbrushes
• Incontinence products like Depends
• Topical ointments like Aspercreme
• Pain medications like Tylenol or Advil
• Stop smoking items

You can place your orders online, by phone, or by mail. The monthly allowance will be automatically loaded onto a FlexCard by Mastercard. Treat it like a debit card and use it anywhere that accepts Mastercard. Unused amounts will roll over to the next month.

Need help?

• Call 1-833-623-2619, Monday–Friday, 8 a.m.–8 p.m.
• Visit MyHealthyFlex.com to view balance, purchase history, and more.
• Download the myTotal Benefits app from the Apple App Store or Google Play. Use this app to scan products while shopping to see if the product is eligible for purchase using your FlexCard.

Prescription Drugs

Your Highmark Health Options Duals prescription drug benefit includes both Medicare Part D and Medicaid prescription drug coverage. When you doctor writes a prescription, your drug coverage includes access to pharmacies where you live, a broad drug list, and mail-order service. Remember to show your Highmark Health Options Duals card each time you visit your pharmacy.

You're covered for all $0 prescription drug copays:

• $0 copay on prescriptions for all tiers (1-5).
• $0 copay during all prescription drug benefit phases.

Note: Applies to Part D drugs only.

Step Therapy

Your Highmark Health Options Duals prescription drug benefits follow rules and coverage limits called step therapy for medically administered Medicare Part B drugs. In some instances, like injectables or biologics, step therapy has you try a preferred drug first before nonpreferred drugs are covered.