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Public program for low income people
Medicare and Medi-Cal benefits
Medicare plan for chronic care needs
Information provided for Community y Más (HMO C-SNP), a Medicare Plan, is for the current benefit year. It is intended to be a summary of the plan. If you need a complete explanation of benefits, services and costs associated with this plan please refer to your Member Handbook.
You can use the drug lookup tool to search our online formulary to see if your medications are covered and what pharmacies you can go to. Please click on the link below to access our Drug Lookup Tool. You will then have to select your income level (based on a family size of 1) to get the most precise drug cost detail.
Certain pharmacies are not available to all members (Home Infusion, Long-Term Care, Indian Health and Specialty). This pharmacy listing does not guarantee that the pharmacy is still in the network. Please contact the Member Services Department at 1-800-232-3133 (TTY 1-855-266-4584 for more information about the pharmacies in our network.
In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies, these are pharmacies that contract with Community y Más to provide your covered prescription drugs. There are some retail pharmacies in Community y Más where you can obtain an extended supply of all medications.
To locate a retail pharmacy in Community y Más network, please call Member Services or review the pharmacy listing.
Community y Más has contracts with over 400 pharmacies that equal or exceed Medicare requirements for pharmacy access in the Plan's approved service area.
In most cases Community y Más only covers drugs filled at an out-of-network pharmacy when a network pharmacy is not available or in case of an emergency.
If you fill your prescription at an out-of-network pharmacy, you may be responsible for paying the full cost of the prescription. You may request Community y Más to reimburse you for your share of the cost by submitting a claim form to the following address:
Community y Más
Attention: Pharmacy & Formulary
2420 Fenton Street, Suite 100
Chula Vista, CA 91914
You may obtain maintenance medications through Community y Más mail-order-pharmacy service. These are prescription drugs that you take on a regular basis for a chronic or long-term medical condition. Please note that these are the only drugs available through our mail-order service.
When you order prescription drugs through Community y Más mail-order-pharmacy service, you must order at least a 31-day supply, and no more than a 93-day supply of the drug. Generally, it takes the mail-order pharmacy 10 days to process your order and ship it to you.
To access the CMS “Best Available Evidence Policy”, please click on the following link. You will be directed to the CMS Website.
Community y Más will cover the drugs listed in our formulary as long as the drug meets the following criteria:
The list of covered drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.
If you need a copy of the drug formulary, or for the most recent list of changes, please contact the Member Services Department at 1-800-232-3133 (TTY 1-855-266-4584). Community y Más representatives are available 24 hours a day, 7 days a week, including holidays. To find out if your drug is on the formulary, please click on the 2024 List of Covered Drugs link to view the additional information regarding Community y Más Formulary. The first part of this formulary booklet tells you how to find a drug on our most recent formulary list.
Click on the following link to access the most recent Formulary/Medication Listing.
Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.
Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.
Over-The-Counter Benefits Catalog
Community y Más members have a new OTC benefit for 2024. You will get $155 every quarter (three months), including tax, to spend on OTC items found in your OTC Catalog. Any unused amount will not carry over to the next quarter. Some limitations may apply. Please refer to the OTC catalog for more information or call the Member Services Department at 1-800-232-3133 (TTY 1-855-266-4584).
Over-The-Counter Benefits Catalog
Over-The-Counter Benefits Catalog - Spanish
Over-The-Counter Benefits Catalog - Vietnamese
There are certain prescription drugs that Community y Más may have additional requirements for coverage or limits. These requirements and limits ensure that Community y Más members use these drugs in the most effective way. These requirements and limits were developed for Community y Más by a team of doctors and/or pharmacists. These requirements were developed to assist us to provide quality coverage to our members.
Generic Substitution: When there is a generic version of a brand-name drug available, Community y Más network pharmacies will automatically give you the generic version, unless your doctor has requested the brand name drug and we have approved this request. You also have the option to request an exception (coverage determination).
Prior Authorization: Community y Más you to obtain prior authorization for certain drugs. Authorized providers will need to obtain approval from Community y Más before filling your prescription. Your prescription drug may not be covered if prior approval is not obtained from the plan. Please click on the following link to access Community y Más Part D Prior Authorization Criteria:
Step Therapy: In some cases, Community y Más requires you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Community y Más may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B.
Community y Más (HMO C-SNP) is an HMO C-SNP health plan with a Medicare contract. Enrollment in this plan depends on contract renewal.
ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-800-232-3133, TTY users should call 1-855-266-4584, 24 hours a day, 7 days a week. The call is free.
ATENCIÓN: Si habla español, hay servicios de asistencia de idiomas disponibles sin cargo. Llame al 1-800-232-3133 (TTY: 1-855-266-4584). Las llamadas a estos números son gratuitas.
请注意:如果您说简体中文,可免费获得语言援助服务。请致电 1-800-232-3133 (听障专线:1-855-266-4584)。通话免费。
PANSININ: Kung nagsasalita kayo ng ibang wika, may mga paglingkod na pagtulong sa wika na maabot ninyo, na libre. Tawagan ang 1-800-232-3133 (TTY: 1-855-266-4584). Liber ang tawag na ito.
請注意:如果您說繁體中文,可免費獲得語言援助服務。請致電 1-800-232-3133(聽障專線:1-855-266-4584)。通話免費。
CHÚ Ý: Nếu bạn nói tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ, miễn phí, sẽ có sẵn cho bạn. Gọi số 1-800-232-3133(TTY: 1-855-266-4584). Cuộc gọi được miễn phí.
1-800-232-3133 تنبيه: إذا كنت تتحدث اللغة العربية ، فأن خدمات المساعدة اللغوية متاحة لك بدون اي مقابل. إتصل بالرقم :
1-855-266-4584او الهاتف النصي :
كلا الرقمين متوفرين ٢٤ ساعة باليوم ٧ أيام بالاسبوع.
توجه: اگر به زبان فارسی صحبت میکنید، خدمات کمک زبانی، به صورت رایگان، در اختیار شماست. با3313-232-800-1 (پیامنگار: 4584-266-855-1) تماس بگیرید. تماس با این شمارهها رایگان است.
Last Website Update 09/20/2024
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