Keystone First covers medically needed Food and Drug Administration (FDA)-approved medicines. Keystone focuses on low-income residents in southeastern Pennsylvania counties including, Bucks, Chester, Delaware, Montgomery, and Philadelphia. Some members who are 21 years or older may have prescription coverage too. You may search the Keystone First VIP Choice 2021 Drug Formulary in several ways: You can use the alphabetical list to search by the first letter of your medication. In addition to the drugs covered by Part D, some prescription drugs are covered for you under your Medicaid benefits. Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. Dental; Eye; Your primary care practitioner ; Special tests for women; Copay schedule; Services when you are sick. Extractions (tooth removals). Keystone First VIP Choice (HMO SNP) is a Local HMO. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. For information about Keystone First VIP Choice call (833) 243-8258 or visit www.keystonefirstvipchoice.com. A coverage determination is any decision (an approval or denial) that Keystone First VIP Choice makes when you ask for coverage or payment of a drug that you believe Keystone First VIP Choice should provide. This means that you will pay the same amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). The Keystone First VIP Choice (HMO D-SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. The plan has a list of covered drugs (formulary). Generic drugs usually cost less than brand name drugs and are rated by the FDA to be as safe and effective as brand name drugs. This site contains links to other Internet sites. Coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association. For members over 18 years old, copays may apply to prescriptions. Coverage by Vista Health Plan, Inc. These reference books are the American Hospital Formulary Service Drug Information (AHFS-DI) and the DRUGDEX® Information System. Keystone First members younger than 21 years old have prescription coverage. * Participants: If you have any problems, call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) 24 hours a day, 7 days a week. Find a pharmacy; Find a medicine; Prescription … Read our Keystone HMO CHIP COVID-19 Alert, and learn more with the CHIP COVID-19 FAQs.For information on care and resources available for COVID-19, visit our COVID-19 site. For members over 18 years old, copays may apply to prescriptions. Keystone HMO Children’s Health Insurance Program (CHIP) Questions about COVID-19 and Keystone HMO CHIP coverage? Pennsylvania Medical Assistance Program Preferred Drug List (PDL) … Please see Terms of Use and Privacy Notice. You do not need a referral to see the dentist. As Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan, Keystone First serves Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Please see the Copayment Schedule (PDF) for more information. Keystone First VIP Choice (HMO D-SNP) is a Local HMO. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. Use this form to send us your appeal. Keystone First Community HealthChoices Participants receive these medical benefits: Preventive care/routine care. This information is not a complete description of benefits. Keystone First is not responsible for the content of these sites. Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. Every year, Medicare evaluates plans based on a 5-star rating system. The formulary has been reviewed and approved by the Centers for Medicare & Medicaid Services (CMS), the agency that administers the Medicare Program. Prescription medicines are prescribed by your health care provider to help keep you healthy, or treat you when you are sick. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Last Update: Wednesday, April 17, 2019 9:52:25 AM. Some members who are 21 years or older may have prescription coverage too. Supported by certain reference books. You will receive notice when necessary. This formulary is a list of prescription medications that are covered under Vista Health Plan, Inc.'s Medicare Advantage Plan in Pennsylvania. Enrollment in Keystone First VIP Choice depends on contract renewal. 1 dental exam and 1 cleaning, per provider/group, every 180 days (6 months). Keystone First VIP Choice covers both brand name drugs and generic drugs. You must continue to pay your Medicare Part B premiums, unless otherwise covered by your Pennsylvania Medicaid benefits. The Keystone First VIP Choice (HMO SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Keystone First was founded by the Sisters … We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. We may or may not agree to waive the restriction for you. (You can then ask us to reimburse you for our share.). It explains how to get coverage for the health care services and prescription drugs you need. Our plan offers members an extensive provider network of physicians, specialists, pharmacies and hospitals. All rights reserved. Contact info Aetna Better Health No limit Patch, gum, lozenge, Nicotine inhaler and spray Bupropion, Chantix $1 Generic $3 Brand Yes Yes Members can call 1-800-QUIT-NOW (784-8669) 1-866-638-1232 Keystone First Health Plan No limit Patch, gum, lozenge, Chantix, Bupropion Nicotine inhaler and spray: need prior authorization $1 Generic $3 Brand … While you are a member of our plan, you must use your plan membership card as well as your Medical Assistance (Medicaid) card to get prescriptions at our network pharmacies. You must have a provider (a doctor or other prescriber) write your prescription. This is an important legal … Coverage for tobacco treatment services? Need help paying for your drugs? Coverage by Vista Health Plan, Inc. The Keystone First VIP Choice (HMO SNP) plan has a $415 drug deductible. Every year, Medicare evaluates plans based on a 5-star rating system. The Keystone First VIP Choice (HMO D-SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Prescription drug frequently asked questions (FAQ). If you need help finding a Keystone First Community HealthChoices dentist, go to Find a Provider and select Dental. Keystone First VIP Choice has a network of pharmacies. Find a pharmacy . History. Keystone First VIP Choice (HMO D-SNP) is a Local HMO. Documents on this page may be updated monthly. Re-cementing of … In most cases, your prescriptions are covered only if they are filled at 1 of our network pharmacies. Keystone First is Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan serving more than 400,000 Medical Assistance recipients in southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Keystone First gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. This site contains links to other Internet sites. We call it the "drug list" for short. The Children's Health Insurance Program (CHIP) is a state- and federally-funded health insurance … Dental emergencies. Need help paying for your drugs? You will receive notice when necessary. At Keystone First VIP Choice (HMO SNP), we understand the needs of people who are eligible for both Medicare and Medicaid. This information is not a complete description of benefits. This plan includes additional Medicare prescription drug (Part-D) coverage. Keystone First, coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania. The formulary is updated at times throughout the year, and the list of drugs may change. A drug formulary is a list of brand and generic medicines covered by … Cleanings. This is called a redetermination or an appeal. Independent Licensee of the Blue Cross and Blue Shield Association. Keystone 65 Select Rx (HMO) (H3952-051) by Keystone 65 - Chester County, PA. Generic drugs have the same active ingredient as brand name drugs. Health maintenance organizations … This site contains links to other internet sites. Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. Independent Licensee of the Blue Cross and Blue Shield Association. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. Please complete the security check below. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. A formulary is a comprehensive list of covered drugs selected by a team of health care providers as a part of a quality treatment program. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. You must use a network pharmacy to fill your prescription. If you get a bill for the services, you may send the bill to Keystone 65 HMO for payment. Health maintenance organizations … Fillings. If you have any questions about this change, please call Member Services at 1-800-521-6860 (TTY 1-800-684-5505). Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. Formulary medications are Food and Drug Administration (FDA) approved and have been chosen for their reported medical effectiveness and value. Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. A network pharmacy is a pharmacy that has agreed to fill covered prescriptions for our plan members. If you have questions about your prescription drug coverage: Keystone … As part of Keystone First CHC, you receive the following dental benefits: Exams. You can search by selecting the therapeutic class of the medication you are looking for. We will pay the non-contracted provider for our share of the bill and will let you know what, if anything, you must pay. This information is not a complete description of benefits. Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, plan ratings, accepted doctors and more. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. This plan is available in PA. Prescription drug benefits Visit your secure account to see prescription drug benefits, check costs or start home delivery. Your drug must be on the plan's list of covered drugs (formulary). For more information, see the prescription drug frequently asked questions (FAQ). Look out for your monthly explanation of pharmacy benefits in the mail. This is a 4-star Medicare Advantage plan. Get 2018 Medicare Advantage information on Keystone First VIP Choice (HMO SNP) from VISTA Health Plan Inc.. This tool will help you find a pharmacy that takes Keystone First in your area. You won’t have to pay a non-contracted provider … With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Enrollment in Keystone First VIP Choice depends on contract renewal. This site contains links to other internet sites. Details Drug Coverage for the VISTA Health Plan Inc. Keystone First VIP Choice H4227-001 (HMO D-SNP) in Pennsylvania. This helps to make sure you have proper drug coverage and limited, if any, cost-sharing responsibility. In most cases, your prescriptions are covered only if they are filled at 1 of our network pharmacies. When we denied your drug, you received a Notice of Denial of Medicare Prescription Drug Coverage. For more information on how to fill your prescriptions, see the Keystone First VIP Choice Evidence of Coverage (PDF). It tells you if there are any rules that restrict coverage for your drugs. This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. The formulary, pharmacy network, and/or provider network may change at any time. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Types of restrictions we use for certain drugs: Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. prescription? You or your primary care provider (PCP) and other prescribers can ask for a coverage determination. If there is a restriction on the drug you want to take, you should contact Member Services to learn what you or your provider would need to do to get coverage for the drug. Plain Page Single Section DnD. The drug list tells you how to find out which drugs are covered under Medicaid. Last Update: Wednesday, April 17, 2019 9:52:25 AM. Find a pharmacy in your network . If you want us to waive the restriction for you, you will need to use the Coverage Determination process and ask us to make an exception. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. It is important to use a network pharmacy because, with few exceptions, you must get your prescriptions filled there if you want our plan to cover the cost. Please see Terms of Use and Privacy Notice. This means that the FDA has approved the drug for the diagnosis or condition for which it is being prescribed. Want regular information about your pharmacy benefits? To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact Keystone 65 Customer Service at 1-800-645-3965 or Personal Choice 65 Customer Service at 1-888-718-3333; TTY/TDD users should call 711, 7 days a week, 8 a.m. to 8 p.m.; or you can complete and submit online the Request for Medicare Prescription Drug Coverage Determination or … A formulary is a list of drugs, or prescriptions, that a plan covers. Remember, your drug must be used for a medically accepted indication. Keystone First members younger than 21 years old have prescription coverage. As a Keystone First VIP Choice member, your Medicare benefits are covered by an affordable, reliable plan. Enrollment in Keystone First VIP Choice depends on contract renewal. 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