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Community Care Prescription Drug Plan for Family Care Partnership.

Address:

Community Care
1555 South Layton Boulevard
Milwaukee , WI 53215

Please contact us Monday through Friday 8:00 AM to 4:30 PM

For information, call (414) 385-6600 or
Toll-Free (866) 992-6600
or TTY Call the Wisconsin Relay System at 711 or 1-800-947-3529.
Para la información, llame (414) 385-6600.

We provide interpreter services free of charge. If you need an interpreter to explain any service or benefit, call (414) 385-6600.

Enrollment

To enroll in Community Care, contact our helpful enrollment specialists at (414) 385-6600 or your local Aging and Disability Resource Center. For more information, contact us.

Service Area

Health, social and personal services (including prescriptions) are available through our Family Care Partnership locations. Choose the county you live in from the drop down menu then choose the program to see Community Care’s location. You may also receive prescription medications from selected retail pharmacies in the area.

Community Care has contracts with pharmacies that equal or exceed CMS’ requirements for pharmacy access in your area. To find a pharmacy, search our provider directory.

Benefits

Community Care’s Prescription Drug Plan provides Family Care Partnership participants with full access to prescription drugs, in accordance with Medicare and Medicaid policies. View the Summary of Benefits.

Use the links below for detailed information related to our prescription drug benefit:

Transition Process
Click here to view our plan transition process. This will tell you how Community Care will help if your current prescription drug is not on the Community Care formulary or if it is taken off of the formulary after you have become a member.

Medication Information
The medications that are ordered for you are on a list known as a formulary.  Community Care’s Formulary is designed to provide medications for virtually all illnesses the elderly may experience.  View our Formulary.

Some medications are not on our Formulary.  If you are currently taking a medication not on our Formulary, you have the right to request an exception in order for this medication be further evaluated for your personal use.  Requests for an exception will be reviewed within 3 business days.  Community Care will grant an exception when it determines that such a medication is medically necessary based upon several factors. See our Exception and Appeals.

Community Care pharmacists will review your medications twice annually.  You may qualify for additional medication review if you have certain conditions and numbers of medications.  This additional review is known as the Medication Therapy Management Program

Premium
Because you are eligible for Medicaid, you do not have to pay a monthly plan premium.

Deductible
The Part D deductible is paid on your behalf and counts toward your out-of-pocket costs.

Cost Sharing
Cost-sharing refers to amounts that you may have to pay for part of your health care costs. Cost-sharing may include any combination of the following types of payments:

  1. any amount members must pay to retain financial eligibility for Wisconsin Medicaid (The federal government refers to this as the “post-eligibility treatment of income.”);
  2. any amount a member residing in substitute care must pay for room and board; and
  3. for members with Medicare Part D, any fixed “co-payment” amounts for which payment is required when Medicare Part D drugs are received.

Co-payment
A co-payment is the fixed amount you pay each time you fill a prescription.  Our plan has two tiers, and every drug is in one of the two tiers.  Depending on your income level, your Medicare Part D copayment will be either:

  • Tier 1 co-payments are $0 to $2.50 for generic drugs
  • Tier 2 co-payments are  $0 to $6.30 for brand drugs

Supplemental Security Income

Individuals who receive Supplemental Security Income (people 65 years and older and people with disabilities who meet Social Security’s financial requirements) are automatically covered under Wisconsin Medicaid. Individuals may apply for Supplemental Security Income at the nearest federal Social Security office. To set up an appointment, call the toll-free number (800) 772-1213 between 7 a.m. and 7 p.m. TDD–(800) 325-0778

 

 

Frequently Requested Links

To find the best available evidence (BAE) to see if you qualify for the Low Income Subsidy (LIS) please visit this website.
Centers for Medicare & Medicaid Services

Appointment of Representative Form

How to appoint a representative

Medicare Complaint Form

Formulary
(updated: 10.28.14)

Step Therapy Criteria
(updated: 2.25.14)

Prior Authorization Criteria
(updated: 10.28.14)

Redetermination Request Form

Coverage Determination Request Form

Summary of Benefits
(updated: 9.25.13)

Privacy Policy
(updated: 12.18.09)

Handbook EOC
(updated: 1.28.13)

Handbook Medicaid Only
(updated: 1.28.13)

Low Income Subsidy Rider
(updated: 1.3.11)

Annual Notice of Change
(updated: 11.14.13)

Medicare.gov

Best Available Evidence (BAE)

Member Bill of Rights

Ombudsman

www.iselfdirect.org

 

 

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