Prescription Drug Coverage
Medication savings and support
With the help of AdhereHealth, we are offering members an opportunity to review their medications with a clinician.
Certain members may receive a phone call from an AdhereHealth clinician to:
- Find ways to save money on prescription costs
- Identify potential medication side effects
- Verify proper medication use
- Coordinate with the member’s health team
- Explore free support services
If contacted by AdhereHealth, we encourage members to take advantage of this no-cost service. If you have questions about this program or AdhereHealth, call Customer Service.
Questions?
We’re a phone call away.
PPO Members:
HMO Members:
Take control of your prescription costs with ease by enrolling in our new Medicare Prescription Payment Plan.
Beginning in 2025, the Medicare Prescription Payment Plan allows beneficiaries to spread out-of-pocket Medicare Part D drug costs evenly across the calendar year (January-December). This voluntary option is available for anyone with a Medicare drug plan or Medicare health plan with drug coverage, making it easier to manage prescription expenses.
Low income subsidy (LIS), also known as Extra Help, is a program that helps individuals who have a limited income pay for their Medicare prescription drug costs.
If you get extra help from Medicare to pay for your prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan.
If you receive extra help, download and refer to the LIS Premium Summary Chart to show you what you’ll pay each month depending on the plan you have and the level of extra help you get:
- PPO LIS Premium Summary Chart – English | Spanish
- HMO LIS Premium Summary Chart – English | Spanish
- Select (HMO) LIS Premium Summary Chart
Best Available Evidence
Johns Hopkins Advantage MD relies on the Centers for Medicare & Medicaid Services (CMS) to determine plan member eligibility for extra help/Low Income Subsidy (LIS). Sometimes, CMS systems may not have the most up-to-date information. If you believe that you are not paying the correct monthly premium or costs for your drugs and are eligible for extra help/LIS, you can submit the Best Available Evidence (BAE) to Advantage MD. Once we receive your BAE, we will ask CMS to update your LIS status in its systems.
Acceptable forms of Best Available Evidence include:
- A copy of your Medicaid card, which includes your name and the eligibility date.
- A copy of a letter from the state or the Social Security Administration (SSA) showing your Medicare LIS status.
- A copy of a state document that confirms your active Medicaid status.
- A screen print from the State’s Medicaid systems showing your Medicaid status.
- Evidence at point-of-sale of recent Medicaid billing and payment in the pharmacy’s patient profile, backed up by one of the above indicators post point-of-sale.
If you have questions about BAE or need help getting documented proof, please call Member Services.
You must mail one of the accepted forms of BAE to:
Johns Hopkins Advantage MD
MD P.O. Box 3538
Scranton, PA 18505
NOTE: For more information, refer to Chapter 2 in your Evidence of Coverage. The full BAE policy is available at CMS.gov.
