Berks Member Guide

21 Lower copays for diabetic medications Donut hole coverage for insulin medications Save money when you fill covered diabetic insulin medications in the Part D Coverage Gap, otherwise known as the “donut hole.” You pay the same copay in the Coverage Gap Stage as you do in the Initial Coverage Stage. That means you could save hundreds of dollars each year when filling your insulin medications. This applies to covered insulins filled at standard, preferred, or mail-order pharmacies! • $35 copay for 30-day supply • $87.50 copay for 90-day supply Lower copays for covered brand-name diabetic medications You can save money on covered brand-name diabetic medications that help lower your blood sugar. Copays for these medications are as low as $10 when you fill a 30-day supply at a preferred pharmacy or $20 when you fill a 90-day supply at preferred or mail-order pharmacies. Lower copays for non-insulin brand-name diabetic medications apply only to the Initial Coverage Stage and do not apply to the HMO Premier Rx plan. Members who receive Low Income Subsidy (Extra Help paying for Part D prescriptions) will not have reduced copays or reduced insulin costs. These benefits do not apply to the HMO No Rx plan and some employer group plans. See your plan formulary for more information. Managing diabetes can be a challenge. That’s why we’re here to help make living with diabetes a little easier. As a UPMC for Life member, you have access to wellness tools and resources that you can use to help you make healthy changes. And the best part? You can use these programs at no additional cost. Health coaches and personal care managers. We can help you understand your current health and how it can be improved. We also have registered nurses and social workers who can work with your doctors, pharmacy, insurance, and other health care providers to make sure you’re getting the right care. To get started, call us at 1-855-395-8762 (TTY: 711) Monday through Friday from 8 a.m. to 5:30 p.m. Prescription for Wellness. Schedule an annual wellness visit with your doctor to discuss your health. If your doctor participates in the Prescription for Wellness program, they can write you a prescription to work with a health coach. Your health coach can help you make healthy changes and work toward your health goals. Diabetes Prevention Program. This lifestyle change program can help you lose weight, adopt healthy habits, and reduce your risk of developing type 2 diabetes. This program is available at no cost to qualified members. The program offers: • Lessons that focus on healthier food choices and staying active. • One-on-one interactions with a lifestyle health coach. • 16 weekly lessons over six months. • Small-group classes so you can receive motivation and support from your peers. To learn more about this program, call 1-844-503-5118 (TTY: 711) Monday through Friday from 9 a.m. to 9 p.m. You can also visit www.solera4me.com/upmc-medicare. Living healthier with diabetes