medicare part d prescription drug plan (pdp) - garity for small to mid market employers &...

Copyright 2016, EnvisionRxOptions – All rights reserved 1

Medicare Part D Prescription Drug Plan (PDP)

Confidential

CONFIDENTIALCopyright 2016, EnvisionRxOptions – All rights reserved 2

EnvisionInsurance is a division of EnvisionRxOptions offering Part D plans to individuals and groups.

Preferred national retail networks & care coordination programs.

PBM for large employers, unions & health plans.

PBM for small to mid market employers & hospice providers.

PBM technologies for claims adjudication.

Mail, Specialty & Compounding.

Individual & Group Medicare Part D Plans.

Rx discounts for under/uninsured.

Discounts & coordination for fertility drugs.

CONFIDENTIALCopyright 2016, EnvisionRxOptions – All rights reserved

• EnvisionRxOptions employs over 1,500 people & was acquired by Rite Aid in 2015.

• The acquisition improved our retail network options & expanded our access to retail clinics, limited distribution drugs & clinical programs.

• EnvisionInsurance was launched in 2007 & currently serves 400,000 members through our PDP product, EnvisionRxPlus.

• EnvisionRxPlus is an Ohio Insurer & a core business for the company that is committed to superior service, an ethical culture & CMS compliance.

• Life & Health license in 50 states & D.C.

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Who We Are: Commitment, Focus & Expertise


New look, same Medicare Part D Prescription Drug Plan offered through EnvisionInsurance.


2017 Plan Benefits


The EnvisionRxPlus plan will no longer be called Clear Choice in 2017. It has been filed with CMS as a Basic Alternative and not an Enhanced plan. PREMIUM REDUCTION TO $14.60Service Area New In 2017Connecticut DelawareMassachusetts District of ColumbiaMaine MarylandMichigan OhioNew Hampshire GeorgiaOregon New YorkPennsylvania North CarolinaRhode IslandSouth CarolinaVermontWashingtonWest Virginia

Plan Year: 2017Plan Type: Basic AlternativePlan Name: EnvisionRxPlusPremium: $14.60


Deductible Applies for drugs in tiers 3-5Amount Varies by Region: $260-$280

Initial Coverage StageAmount paid until the beneficiary and the plan pays a total of $3,700

for covered prescription drug expenses.

30-Day SupplyBeneficiary pays…

90-Day Supply (For tiers 1 through 4)

Beneficiary pays…

Tier NamePreferred

Cost SharingStandard

Cost SharingPreferred

Cost SharingStandard

Cost SharingTier 1 – Preferred Generics $1 $14.90 $3 (retail) $2 (mail) $44.70

Tier 2 – Higher Cost Preferred Generics $15 $20 $45 $60Tier 3 – Preferred Brand & Preferred Generics 10% 20% 10% 20%Tier 4 – Non-Preferred Brand & Non-Preferred Generics

VARIES BY REGION: 24% - 27% preferred pharmacy cost share or 32% - 42% non-preferred pharmacy cost share

Tier 5 – Specialty Drugs 27% 27% Not offered Not offered

EnvisionRxPlus 2017 Benefit Plan


Coverage Gap StageBeneficiaries reach the “Coverage Gap” stage

when the amount paid for their out-of-pocket costs, are between $3,701 and $4,95030 or 90-day supply, beneficiary pays:

Generic No more than 58% of the costBrand 40% of the negotiated price

Catastrophic Coverage StageBeneficiaries reach the “Catastrophic” stage when the cost sharing amounts total $4,951. This is the stage when the

plan pays the most.

30 or 90-day supply, beneficiary pays:Generic Greater of $3.30 or 5%Brand Greater of $8.25 or 5%

EnvisionRxPlus 2017 Benefit Plan


A Scope of Appointment is required for all sales; face-to-face, telephonic, etc.

Applications can be submitted;

Preferred: Electronically via portal/website

Faxed to 844.293.4756

Submission of Application


Agent Compensation

• $71 for initial enrollments

• $36 for plan changes or reenrollments

• Payments will no longer be prorated after the Annual Enrollment Period ends

• Brokers will be paid every month between the 15th & 25th


Participating Pharmacies

Over 50,000; including most major pharmacy chains & many independents

medicare part d prescription drug plan (pdp) - garity for small to mid market employers &...

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