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Additional Plan Information

FHCP Medicare Pharmacy Network & Mail Order

Network Pharmacies

FHCP Medicare Pharmacy network consists of:

  • Preferred Retail Pharmacies - A network pharmacy that offers covered drugs to members of our plan at lower cost-sharing levels than at a network standard retail pharmacy
  • Contracted Standard Retail Pharmacies - A network pharmacy that offers covered drugs to members of our plan at higher cost-sharing levels than at a network preferred retail pharmacy
  • Mail Order pharmacy,
  • Home Infusion pharmacies and
  • Long-term Care pharmacies.

Mail Order

You can use the FHCP Medicare’s mail order network. Generally the drugs provided through FHCP’s Mail Order Pharmacy are drugs that you take on regular basis, for a chronic or long-term medical condition. These are the only drugs available through FHCP’s Mail Order Pharmacy and are marked as “mail-order” drugs in our Drug List.

When you order prescription drugs by mail, you must order at least a 62-day supply and no more than a 93-day supply of the drug.

To get order forms and information about filling your prescriptions by mail, call:

FHCP’s Mail Order Pharmacy

  • 386-676-7126 or 1-800-232-0216

    Hours of operation: 8:30 a.m. - 5:30 p.m. local time, Monday through Friday

  • Hearing Impaired: 1-800-955-8770

    Please note: You must use FHCP’s Mail Order Pharmacy. Prescription drugs that you get through any other mail order pharmacy are not covered.

When can you use a pharmacy that is not in the plan’s network?

Your prescription may be covered in certain situations

Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. If you cannot use a network pharmacy, here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

  • If you are traveling within the United States and its territories and become ill, lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy. Coverage in this situation will be for a temporary 31-day supply of medication, or less if your prescription is for fewer days.

  • We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgent care.

  • We will cover your prescription at an out-of-network pharmacy if at least one of the following applies: If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.

  • If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail pharmacy (including high-cost and unique drugs).

  • If you are getting a vaccine that is medically necessary but not covered by Medicare Part B.

Please Note: If you purchase a drug at an out-of-network pharmacy, and one of the situations explained above applies to you, you may be reimbursed at our plan’s standard in-network pharmacy rate, not the full price that you paid for the drug. Additionally, the difference in the plan’s reimbursement amount and the total amount you paid for the drug will be included in your total out-of-pocket costs.

When none of the situations explained above apply and you voluntarily pay out-of-pocket for a drug, you will be responsible for paying the total cash price of the drug, and you will not be reimbursed by our plan. The amount you pay will not apply toward your total out-of-pocket costs. In these situations, please check first with Member Services to see if there is a network pharmacy nearby. (Phone numbers for Member Services are printed on the back cover of this booklet.) You may be required to pay the difference between what you pay for the drug at the out-of-network pharmacy and the cost that we would cover at an in-network pharmacy.

How do you ask for reimbursement from the plan?

If you must use an out-of-network pharmacy, you will generally have to pay the full cost (rather than your normal share of the cost) at the time you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim to

FHCP Medicare’s pharmacy network includes limited lower-cost, preferred pharmacies in Brevard, Flagler, Seminole, St. Johns and Volusia counties, Florida. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-866-6559 (TTY user call 1-800-955-8770) or consult the online pharmacy directory at www.fhcpmedicare.com.


Florida Health Care Plans
Attn: Claims Department
P.O. Box 9910
Daytona Beach, FL 32120

Medication Therapy Management Program (MTMP)

Medication Therapy Management

What is Medication Therapy Management?

The Medication Therapy Management (MTM) program reviews the medicines you take to make sure that they’re safe, work well and fit your lifestyle. This program is offered at no additional cost to eligible members. This service is not considered a benefit.

The goal is to help you get the best results from your medicines, at the lowest possible price. The MTM program is the right choice if you need answers to questions below

  • Why am I taking these medicines?
  • Do over-the-counter products interact with my prescriptions?
  • Can I save money on my prescriptions?

The program can also help you and your doctor make sure that your medicines are the best choice for you.

Who's eligible for MTM?

You're automatically enrolled in the MTM program if you meet the criteria listed below.

2019

1. Have three or more of the following conditions:

  • Alzheimer’s Disease
  • Anemia
  • Atrial Fibrillation
  • Anticoagulation
  • Cardiovascular
  • Cerebrovascular Disease
  • Chronic Heart Failure
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • End-Stage Renal Disease (ESRD)
  • High blood pressure
  • High blood cholesterol
  • Rheumatoid arthritis
  • Respiratory Disease- Chronic Lung Disorders

AND

2. Take eight or more prescription medications covered by Medicare Part D.

AND

3. Expect to spend more than $4.044 in 2019 on prescription medicines covered by Medicare Part D.

Paula Call for more information on Medication Therapy Management

What can you expect?

The MTM program is a two-part program. Reviews may be done over the phone, whenever it’s convenient for you. In some cases, you may have an in-person review.

1. Comprehensive Medication Review (CMR)

This personalized review lets you talk one-on-one with an MTM pharmacist.

To get ready for your review make a list of all the medicines you take. Write down even over-the-counter medicines or supplements. Include how much you take each day and how often you take them. The pharmacist will review your list and talk about it with you. This usually takes about 30 minutes.

After your review, you’ll get a complete list of your medicines - a personal medication list and an action plan that you can bring with you to your next doctor’s visit.

2. Targeted Medication Review (TMR)

Every few months, the program reviews your prescription claims to make sure there are no issues that need attention. If the review identifies any issues, we may contact your doctor.

Getting Started

If you’re eligible for MTM, you’re automatically enrolled. You’ll get a letter or phone call letting you know how to schedule an appointment or opt out of the program.

Opting out

Medicare requires us to automatically enroll you if you’re eligible. But, this service is voluntary - you’re not required to participate. You may also choose to take part in only certain services you find valuable. You can change your enrollment status at any time during the calendar year. Your prescription drug coverage will not change if you take part in the MTM program or not.

For more information

2019 MTM informational brochure

If you'd like to know more, call the customer or member service phone number on the back of your member ID card. Ask to speak to someone about the MTM program.

The MTM Program is a service offered to eligible members at no extra cost; this service is not considered a benefit.


FHCP Medicare Preferred Fitness

Good health is your best defense against illness and disease. At FHCP Medicare, we are dedicated to maximizing your health and well-being. In order to help you achieve your personal health and fitness goals, we invite you to take advantage of our unique Preferred Fitness Program. This program is available to all FHCP Medicare members. Preferred Fitness will help you improve your health, reduce your risk of future disease, increase your energy, and meet new friends!

As a member of the Preferred Fitness Program, you will have free, unlimited access to participating fitness centers and gyms in Brevard, Flagler, Seminole, St. Johns and Volusia Counties. For specific questions or concerns, current FHCP members may call 386-615-5051, or 833-866-6559 (TTY user should call 1-800-955-8770). From October 1 through March 31, we are open 8 a.m. - 8 p.m. local time, seven days a week. From April 1 through September 30, we are open 8 a.m. - 8 p.m. local time, Monday - Friday. You will have to leave a message on Saturdays, Sundays and Federal holidays. We will return your call within one business day.

Emergency & Disaster Care

If the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to care from FHCP Medicare.

If you need medical care during a disaster or emergency and you cannot access one of our network physicians or facilities, you may obtain care from an out-of-network provider and pay the in-network cost-sharing amount. You will also pay in-network cost-sharing for covered prescriptions you receive from out-of-network pharmacies during a declared disaster or emergency.

No prior authorization or referral rules apply to covered services or supplies you receive during a disaster or emergency.

Medical providers and pharmacies from which you receive services or supplies during a disaster or emergency should bill FHCP Medicare for your care, regardless of their contracting status with our plan.

In most cases, the official who declared a disaster or emergency will announce when the disaster or emergency is over. However, if the disaster or emergency time period has not been closed 30 days after the first declaration and the Centers for Medicare & Medicaid Services (CMS) has not specified an end date to the disaster or emergency, our plan will resume normal operations 30 days after the first declaration.

For information on the status of a disaster, please visit fema.gov/disaster.

If you have questions or concerns about accessing care during a disaster or emergency, please call our Member Services Department at the numbers shown below.

  • Local: 386-615-5051
  • Toll Free : 833-866-6559
  • TTY: 800-955-8770
  • Hours of operation: From October 1 through March 31, we are open 8 a.m. - 8 p.m. local time, seven days a week. From April 1 through September 30, we are open 8 a.m. - 8 p.m. local time, Monday - Friday. You will have to leave a message on Saturdays, Sundays and Federal holidays. We will return your call within one business day.