Soundpath Health Prescription Drug Coverage

Prescription drugs are an important consideration when making decisions about your medical coverage. Part D is the Medicare prescription drug program. The program is managed by private companies approved by CMS and is a voluntary benefit. However, penalties may apply if you don't sign up for Medicare Part D at the time you are initially eligible. Monthly premiums vary by plan and product selected.

Soundpath Health has four benefit plans that provide coverage for Part D in both 2011 and 2012. We have one formulary (list of covered drugs) that describes the coverage for our plans. Below is a chart that outlines the coverage for each benefit plan. You may click on the Formulary button on the side to see the drug tier, copayment and any limitations for each of the covered drugs listed in the Formulary.

Soundpath Health Network Pharmacies

When your plan includes Part D prescription coverage, you can use any of the pharmacies in the extensive pharmacy network to have your covered prescriptions filled.Our network includes over 750 retail pharmacies so, chances are, you can find several in your neighborhood to choose from. Plus we offer a prescription drug mail-order service that can provide a convenient way to receive your long-term prescription drugs. Soundpath Health has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. To locate a pharmacy, call us, or click here to review the 2012 Provider/Pharmacy Directory.

2012 Plans	Sound+Rx	Pinnacle+Rx	Charter+Rx	Apex +Rx
Deductible	$320 Tier 1 - $6 Copay	$320 Tier 1 - $6 Copay	$0	$0
Tier 1 Preferred Generic Drug Copay	$6	$6	$6	$6
Tier 2 Non-Preferred Generic Drug Copay	$18	$18	$18	$18
Tier 3 Preferred Brand Drug Copay	$36	$36	$36	$36
Tier 4 Non-Preferred Brand Drug Copay	$60	$60	$60	$60
Tier 5 Specialty Drug Coinsurance	25%	25%	33%	33%
Coverage Gap	$4,700 No Gap Coverage	$4,700 No Gap Coverage	$4,700 Tier 1 - $6 Copay	$4,700 Tier 1 - $6 Copay Tier 2 - $18 Copay

For additional information regarding Part D coverage, please refer to the Evidence of Coverage.

Important Formulary Information

Click here to download Adobe Reader to view Soundpath Health's formulary.

2012 Formulary Documents
2012 Comprehensive Formulary   2012 Step Therapy Requirements   2012 Prior Authorizations

Other Important Information

• If a beneficiary would like to appoint a person to file a grievance, request a coverage determination or exception, or request an appeal on his or her behalf, the beneficiary and the person accepting the appointment must fill out this form (or a written equivalent) and submit it with the request.

• Medicare Part D Coverage Determination Request Form (for use by enrollees) located on CMS’s Part D appeals webpage.

• Medicare Part D Coverage Determination Request Form (for use by provider) located on CMS’s Part D appeals webpage.

• Information on future formulary changes for May, June and July.

  * Eligible beneficiaries must use network pharmacies to access their prescription drug benefit (except under non-routine circumstances). Quantity limitations and restrictions may apply.

Page Last Updated: December 7, 2011