Sometimes you are taking a drug that is not on our formulary. Please click the link to review the Medicare Part D Transition Policy.
During the time when you are getting a temporary supply of a drug, you should talk with your doctor or provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.
In some cases, residents of a long-term care facility may access their prescription drugs through their long-term care pharmacy.
You may find participating long-term care pharmacies in our Pharmacy Directory.
You may have coverage for home infusion therapy.
Capital Health Plan Medicare Advantage (HMO) plans will cover home infusion therapy when:
You may find participating Home Infusion Pharmacies in our Pharmacy Directory.
Capital Health Plan will cover certain kinds of drugs through the plan's network mail-order service.
Generally, the drugs available through mail order are drugs that you take on a regular basis, for a chronic or long term medical condition. The drugs that are not available through the plan's mail-order service are Tier 5 Specialty medications.
Our plan's mail-order service allows you to order up to a 90-day supply. Members can expect to receive their drugs within 14 days. Call Member Services with questions or if your drugs to not arrive within this time frame.
Capital Health Plan Medicare Advantage (HMO) members have access to over 50,000 retail pharmacies nationwide. Access meets or exceeds standards set by the Centers for Medicare and Medicaid Services (CMS).
This means that:
You have rights and responsibilities if you leave Capital Health Plan Retiree Advantage (HMO).
You may end your membership in our plan only during certain times of the year known as enrollment periods.
If you have questions about enrollment periods please contact your employer or former employer's benefit's department or Capital Health Plan Member Services at the numbers listed on this page.
If you are traveling within the United States and territories and become ill, or lose or run out of your prescription drugs, remember that Capital Health Plan (CHP) has over 50,000 retail pharmacies in our pharmacy network. To find a pharmacy simply check our Pharmacy Locator or call Member Services at 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – February 14; 8:00 a.m.
End of life decisions about medical care can be much easier when advance directives are used. An advance directive simply means a statement, made while you are competent, about the medical treatment you want when you consciously cannot make decisions. Decisions made early and communicated plainly may have tremendous value for the person and the family.
The state of Florida provides excellent information about health care advanced directives.
This section gives information on what to do if you need to ask us to make an exception to our Part D prescription drug coverage rules.
**You cannot request coverage for a prescription drug that does not meet the definition of a Part D drug. There are a few specific drugs that your Medicare plan cannot cover.**
This section describes your rights to request coverage of a Part D prescription drug or payment for a Part D prescription drug that you have purchased. You also may make a complaint about your prescription drug benefits and coverage.
To learn about your rights to make complaints about your medical benefits and coverage, please go to this section of the site.
By clicking on this link you will be leaving the Capital Health Plan Medicare Advantage (HMO) information.