Additional Plan Information

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

To get information about filling your prescriptions by mail, call FHCP’s Mail Order Pharmacy at

• 1-386-676-7126 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 will not be 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. To help you, we have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Please check first with Member Services to see if there is a network pharmacy nearby. You will most likely 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.

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 or mail-order pharmacy (including high-cost and unique drugs).
• If you are getting a vaccine that is medically necessary but not covered by Medicare Part B.

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 cost-share) 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
Attn: Claims Department
P.O. Box 10348
Daytona Beach, FL 32120-0348

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.

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 right for you 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.

2023

1. Have three or more of the following conditions: Anemia Atrial Fibrillation Anticoagulation Chronic Heart Failure Diabetes End-Stage Renal Disease (ESRD) Hypertension Dyslipidemia Respiratory Disease- Chronic Lung Disorders Bone Disease-Arthritis-Osteoporosis AND

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

3. Expect to spend more than $4,935 in 2023 on prescription medicines covered by Medicare Part D.

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

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.

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!

Gym List

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 1-833-866-6559 (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, except for Thanksgiving and Christmas. From April 1 through September 30, we are open 8 a.m. - 8 p.m. local time, Monday - Friday, except for major holidays.

FHCP Medicare will take immediate action when either:

• The Secretary of Health and Human Services declares a public health emergency, or
• A governor or the U.S. President declares a disaster or other type of emergency.

Members living in affected areas can still get the medical care and prescription drugs they need. We work fast to help members during a state of emergency or disaster declaration. When it’s in the members’ best interest for us to do so, we won’t wait for the usual 30 days’ required notice to make these changes. We’ll get right on it.

Medical Services

• We will cover Medicare Parts A, B and supplemental Part C plan benefits at Medicare participating non-network hospitals and other medical facilities.
• Members will not need to have a referral from their primary care doctor (PCP) for If a provider accepts Medicare or is a Medicare-certified facility, we’ll cover the service. This includes dialysis services.
• Members will pay in-network cost sharing even if they use out-of-network providers in these situations.

Prescription Drugs

• When a state of emergency is declared, FHCP Medicare will temporarily allow affected members to get an early refill of their medications and maximum extended-day supplies from in-network pharmacy providers.
• Members who use out-of-network pharmacies may not have prescription coverage. If you can’t access your usual network pharmacy, call us at the number on the back of your FHCP Medicare ID card. Our Member Services team will help you find a network pharmacy to use. If there is not a network pharmacy reasonably available for you to use, you will be able to use an out-of-network pharmacy. However, the cost for your prescription drugs may be higher.
• Does your medicine need our approval before you can fill it? Call our Member Services team at the number on the back of your FHCP Medicare member ID card for help.

These actions will remain in effect until either:

• The governor, HHS Secretary, or President declares the public health emergency or disaster has ended, or
• 30 days have passed since the disaster or emergency was declared and no end date was given.

If FHCP Medicare Offices Are Impacted

If the disaster or state of emergency affects FHCP Medicare’s offices and we cannot resume operations by the end of the disaster or emergency, we’ll notify the Centers for Medicare & Medicaid Services (CMS). We’ll also update our FHCP website when we’re able to do so with information about our business activities and hours of operation.

We'll Keep You Updated

We’ll keep you updated with important information online. Visit fhcpmedicare.com for the latest information about using your medical or prescription drug benefits during a disaster or state of emergency. For round-the-clock information about benefits, in-network providers, and more log in to your Member Portal at fhcpmedicare.com