Tshuaj thiab Medicare Part D Pharmacy Benefits

Yog tias koj xav tau cov tshuaj los kho koj tus mob lossis mob, koj tus kws kho mob yuav muab tshuaj rau koj. Yog tias koj muaj lus nug txog koj cov tshuaj, nco ntsoov nug tus kws muag tshuaj. Lawv nyob ntawd los pab koj.

Muaj peb txoj hauv kev kom paub seb cov tshuaj twg raug them:

1. Koj tuaj yeem tshawb nrhiav cov tshuaj tiv thaiv los ntawm generic lossis hom npe lossis los ntawm qeb hauv peb List of Covered Drugs (Formulary).
2. Koj tuaj yeem ua tau download tau ib daim qauv ntawm Formulary.
3. Koj tseem tuaj yeem hu rau Cov Chaw Pabcuam Tswvcuab thiab hais kom lawv xa ib qho rau koj.

Kev them nqi rau koj cov tshuaj yuav txawv raws li qib Kev Pab Ntxiv uas koj tau txais los ntawm Medi-Cal. Thov saib koj Pov Thawj ntawm Kev Pabcuam (Member Handbook) kom paub meej. Cov nyiaj them poob haujlwm tuaj yeem hloov pauv thaum Lub Ib Hlis 1 ntawm txhua xyoo.

TotalCare suav nrog cov tshuaj muaj npe thiab cov tshuaj uas muaj nyob hauv cov khw muag tshuaj network. Txhawm rau nrhiav lub khw muag tshuaj network nyob ze koj, tshawb xyuas peb Online Pharmacy Directory.

Yog tias koj tab tom sau lossis rov sau daim ntawv xaj, koj yuav tsum siv lub tsev muag tshuaj uas ua haujlwm nrog TotalCare lossis Medi-Cal Rx. Txhawm rau nrhiav lub khw muag tshuaj network nyob ze koj, siv lub Online Pharmacy Directory.

Nco tseg: Hauv cov ntawv rub tawm thiab luam tawm ntawm cov chaw muag tshuaj, koj yuav pom cov npe ntawm cov chaw muab kev pabcuam. Cov npe kws tshuaj thiab tus kws kho mob nyob hauv tib daim ntawv.

Sau koj cov tshuaj

Thaum koj mus rau lub tsev muag tshuaj, nco ntsoov nqa:

• Koj daim npav TotalCare Member ID.
• Koj daim Medi-Cal Benefits Identification Card (BIC).

Lub tsev muag tshuaj yuav siv daim npav no los nrhiav koj cov ntaub ntawv thiab muab koj cov tshuaj rau koj. Yog tias koj tau txais ib daim nqi rau cov tshuaj, hu rau TotalCare Cov Kev Pabcuam Tswvcuab ntawm tus lej teev nyob hauv qab ntawm nplooj ntawv.

Koj yuav tsum tau txais koj daim BIC thaum koj thawj zaug tau txais kev pabcuam Medi-Cal. Muaj ob (2) ntau hom BIC. Ob leeg ua haujlwm.

Mus rau www.medimpact.com kom sau npe thiab tswj koj cov ntawv yuav tshuaj. Yog xav tau cov ntaub ntawv hais txog kev sau koj cov ntawv yuav tshuaj los ntawm kev xa ntawv, hu rau SortPak Pharmacy ntawm 877-570-7787 (TTY: 711) lossis Birdi ntawm 855-873-8739 (TTY: 711).   

Qhov Kev Tswj Xyuas Tshuaj Kho Mob (MTM) yog ib qho kev pabcuam ntxiv uas muaj yam tsis tau them nqi rau cov tswvcuab TotalCare uas muaj qee yam mob. Qhov kev pabcuam no yog muab los ntawm MedImpact, sawv cev ntawm TotalCare. Qhov kev pab cuam no pab koj thiab koj tus kws kho mob kom paub tseeb tias koj cov tshuaj muaj kev nyab xeeb thiab ua haujlwm zoo. Koj tuaj yeem kawm paub ntau ntxiv ntawm qhov página del Programa de MTM.

Kev Tso Cai Ua Ntej (PA): Cov tshuaj no muaj nyob rau hauv TotalCare Formulary tab sis yuav tsum tau pom zoo ua ntej koj tuaj yeem sau koj daim ntawv xaj. Qhov no kuj suav nrog cov cai rau thaum twg cov tshuaj no tuaj yeem pom zoo. Saib cov npe tshuaj nrog Cov Cai Ua Ntej Tso Cai.

Therapy Criteria (ST): Qee cov tshuaj raug them tsuas yog tom qab koj tau sim lwm yam tshuaj uas pom zoo, tab sis nws tsis ua haujlwm. Yog tias muaj ob yam tshuaj uas kho koj tus mob, tej zaum koj yuav tau sim ib qho ua ntej TotalCare npog lwm qhov. Saib daim ntawv teev cov tshuaj nrog cov txheej txheem kho mob.

TotalCare muaj cov cai hais txog leej twg tuaj yeem tau txais qee yam tshuaj. Piv txwv li:

• TotalCare tuaj yeem them rau cov tshuaj uas koj tus kws kho mob tau sau tseg, tab sis koj yuav tsis ua raws li cov cai.
• TotalCare tej zaum yuav tsis them cov tshuaj uas koj tau noj lawm vim muaj kev hloov pauv ntawm cov qauv.

Qee zaum, TotalCare ua qhov kev zam yog tias tus kws kho mob sau ntawv hais tias muaj laj thawj kev kho mob vim li cas koj thiaj li xav tau qee yam tshuaj. Qhov no yog hu ua "formulary exception."

Yuav ua li cas thov ib qho kev zam txim
Koj tus kws kho mob yuav tsum hu rau MedImpact. Tom qab ntawd koj tus kws kho mob yuav fax lossis xa ib tsab ntawv sau rau MedImpact uas piav qhia txog vim li cas kho mob rau qhov kev thov no.

Koj tuaj yeem nug MedImpact kom txiav txim siab txog kev them nyiaj hauv xov tooj ntawm 800-788-2949 lossis los ntawm lawv lub vev xaib.

Koj tuaj yeem nug MedImpact rau ib qho Daim Ntawv Qhia Txog Kev Txiav Txim Them Nqi Them Ntu D. Koj tuaj yeem xa daim foos no mus rau MedImpact los ntawm kev xa ntawv lossis fax:
10181 Scripps Gateway Court
San Diego, CA 92131
Tus Fax: 858-790-7100

Raws li txoj cai, muaj cov tshuaj uas TotalCare thiab Medi-Cal Rx tsis tuaj yeem them. Koj tseem tuaj yeem tau txais cov tshuaj uas tsis raug them, tab sis koj yuav tau them tus nqi tag nrho koj tus kheej.

Opioids yog ib pawg tshuaj uas kws kho mob tau sau los pab koj tswj qhov mob. Lawv tuaj yeem pab rau lub sijhawm luv luv, tab sis siv lawv rau lub sijhawm ntev tuaj yeem ua rau muaj kev pheej hmoo. Yog tias koj tab tom noj lossis txiav txim siab noj tshuaj opioids ntau tshaj peb lub hlis, nws yog ib qho tseem ceeb kom paub txog cov kev mob tshwm sim thiab kev xaiv zoo dua. Koj tuaj yeem kawm paub ntau ntxiv ntawm peb Nplooj ntawv xov xwm Opioid.

Yog tias koj yog ib tus tswv cuab tshiab thiab tab tom noj cov tshuaj uas tsis nyob hauv peb Formulary (cov npe ntawm cov tshuaj them), koj yuav tsum tau ua raws li peb cov txheej txheem hloov tshuaj. Kawm txog koj cov kev xaiv rau cov txheej txheem no hauv ntu no. Koj tseem tuaj yeem nyeem peb Txoj cai hloov pauv.

Qhov Kev Pab Them Nqi Them Nqi Medicare yog qhov kev xaiv them nyiaj yeem ua haujlwm nrog koj qhov kev pab them nqi tshuaj tam sim no. Nws tuaj yeem pab koj tswj koj lub hnab tshos tawm ntawm Medicare Part D cov nqi tshuaj los ntawm kev nthuav tawm lawv thoob plaws lub xyoo (Lub Ib Hlis-Lub Kaum Ob Hlis). Qhov kev xaiv them nyiaj no tuaj yeem pab koj tswj koj cov nuj nqis, tab sis nws tsis txuag koj cov nyiaj lossis txo koj cov nqi tshuaj.

Qhov kev xaiv them nyiaj no yuav tsis raug rau koj yog tias koj twb tau txais kev pab them rau koj cov nqi kho mob los ntawm cov kev pab cuam xws li Kev Pab Ntxiv los ntawm Medicare lossis Lub Xeev Pharmaceutical Assistance Program (SPAP). Hu rau TotalCare Kev Pabcuam Tswvcuab kom paub ntau ntxiv.

Daim Ntawv Thov Koom Tes Nrog Kev Them Nqi Tshuaj ntawm TotalCare (HMO D-SNP) 

Nws yog ib qho tseem ceeb kom muaj kev nyab xeeb kom tshem tau cov tshuaj tsis xav tau lossis tas sij hawm thiab cov ntse zoo li no:

• Hypodermic koob.
• Koob koob.
• Pre-loaded sharps.
• Auto-injectors.
• Cov koob txhaj tshuaj.
• Lancets.
• Lwm cov cuab yeej siv los tho rau ntawm daim tawv nqaij los kos ntshav los yog xa cov tshuaj.

Sharps yuav tsum tau khaws cia rau hauv cov thawv ntim tau pom zoo los ntawm US Food and Drug Administration. Koj lub nroog muaj qhov chaw tso tawm rau ob qho tshuaj thiab cov ntse:

Lub Nroog Mariposa

• Cov chaw tso tshuaj rau Mariposa County
• Sharps tso tawm qhov chaw rau Mariposa County

Merced County

• Cov chaw tso tshuaj rau Merced County
• Sharps cov chaw tso tawm rau Merced County
• Merced County Department of Public Health

Lub Nroog Monterey

• Cov chaw tso tshuaj rau Monterey County
• Sharps tso tawm qhov chaw rau Monterey County
• Lub Nroog Monterey Health Department

Lub Nroog San Benito

• Cov tshuaj thiab sharps tso tawm qhov chaw rau San Benito

Lub Nroog Santa Cruz

• Cov chaw tso tshuaj rau lub nroog Santa Cruz