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Farmacopea De 2021 (Lista De Medicamentos Cubiertos)

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Farmacopea De 2021 (Lista De Medicamentos Cubiertos) Planes Medicare Advantage de ConnectiCare Plan ConnectiCare Choice 1 (HMO) Plan ConnectiCare Choice 2 (HMO) Plan ConnectiCare Choice 3 (HMO) Plan ConnectiCare Choice Part B Saver Plan ConnectiCare Flex 1 (HMO-POS) Plan ConnectiCare Flex 2 (HMO-POS) Plan ConnectiCare Flex 3 (HMO-POS) Plan ConnectiCare Passage 1 (HMO) Farmacopea de 2021 (Lista de medicamentos cubiertos) LEA LA SIGUIENTE INFORMACIÓN: ESTE DOCUMENTO CONTIENE INFORMACIÓN SOBRE LOS ME- DICAMENTOS QUE CUBRIMOS EN ESTE PLAN. 00021082, V17 Esta farmacopea se actualizó el 09/01/2021. Para obtener información más reciente o si tiene otras preguntas, comuníquese con Servicios para Miembros de ConnectiCare al 1-800-224-2273, los usuarios de TTY deben llamar al 711, de 8.00 am a 8.00 pm, hora del este, los siete días de la semana, o visite connecticare.com/medicare. Última actualización 09/01/2021 H3528_200567_C Nota para los miembros existentes: Esta farmacopea se ha cambiado desde el año pasado. Revise este documento para asegurarse de que aún se incluyan los medicamentos que usted toma. Cuando esta lista de medicamentos (farmacopea) haga referencia a “nosotros”, “nos” o “nuestro”, significa ConnectiCare. Cuando se refiere a “plan” o “nuestro plan”, significa los planes Medicare Advantage de ConnectiCare. Nuestros planes Medicare Advantage incluyen los planes ConnectiCare Choice 1 (HMO), ConnectiCare Choice 2 (HMO), ConnectiCare Choice 3 (HMO), ConnectiCare Choice Part B Saver, ConnectiCare Flex 1 (HMO-POS), ConnectiCare Flex2 (HMO-POS), ConnectiCare Flex 3 (HMO-POS) y ConnectiCare Passage 1 (HMO). Este documento incluye una lista de los medicamentos (farmacopea) para nuestro plan que se encuentra vigente desde el 09/01/2021 . Para obtener una actualización de la farmacopea, comuníquese con nosotros. Nuestra información de contacto, junto con la fecha de la última actualización de la farmacopea, aparece en la portada y contraportada. Generalmente, deberá utilizar farmacias de la red para hacer uso de su beneficio de medicamentos con receta. Los beneficios, la farmacopea, la red de farmacias o los copagos y el coseguro pueden cambiar a partir del 1.° de enero de 2022 y periódicamente durante el año. Última actualización 09/01/2021 ii ¿Qué es la farmacopea de ConnectiCare? Una farmacopea es una lista de medicamentos cubiertos seleccionados por nuestro plan tras consultar con un equipo de proveedores de atención médica, que representa las terapias con medicamentos con receta que se consideran una parte necesaria del programa de tratamiento de calidad. Generalmente, nuestro plan cubrirá los medicamentos mencionados en nuestra farmacopea siempre que el medicamento sea necesario por motivos médicos, el medicamento con receta se surta en una farmacia de la red del plan y se cumplan otras reglas del plan. Para obtener más información sobre cómo surtir sus medicamentos con receta, revise su Evidencia de Cobertura. ¿Puede modificarse la farmacopea (lista de medicamentos)? La mayoría de los cambios en la cobertura de medicamentos ocurren el 1.° de enero, pero nuestro plan puede agregar o quitar medicamentos de la lista de medicamentos durante el año, moverlos a diferentes niveles de costos compartidos o agregar nuevas restricciones. Debemos seguir las reglas de Medicare al hacer estos cambios. Cambios que pueden afectarle este año: En los casos que figuran a continuación, usted se verá afectado por los cambios de cobertura durante el año: • Nuevos medicamentos genéricos. Podemos eliminar inmediatamente un medicamento de marca de nuestra lista de medicamentos si lo reemplazamos por un nuevo medicamento genérico que estará en el mismo nivel de costos compartidos o en uno más bajo y que tenga las mismas restricciones o menos. Además, al agregar el nuevo medicamento genérico, podemos decidir mantener el medicamento de marca en nuestra lista de medicamentos, pero pasarlo inmediatamente a un nivel de costos compartidos diferente o agregar nuevas restricciones. Si actualmente está tomando ese medicamento de marca, es posible que no le comuniquemos por adelantado antes de realizar ese cambio, pero más adelante le proporcionaremos información acerca de los cambios específicos que hayamos realizado. • Si realizamos dicho cambio, usted o el profesional autorizado para recetar pueden solicitarnos que hagamos una excepción y sigamos cubriendo el medicamento de marca para usted. El aviso que le proporcionamos también incluirá información sobre cómo solicitar una excepción, y además, puede encontrar información en la sección de la página vi titulada “¿Cómo solicito una excepción a la farmacopea de ConnectiCare?” • Medicamentos retirados del mercado. Si la Administración de Alimentos y Medicamentos (FDA) considera que un medicamento de nuestra farmacopea no es seguro o bien si el fabricante retira el medicamento del mercado, retiraremos de inmediato el medicamento de nuestra farmacopea y daremos aviso a los miembros que lo toman. • Otros cambios. Es posible que hagamos otros cambios que afecten a los miembros que actualmente toman un medicamento. Por ejemplo, podemos agregar un medicamento genérico que no sea nuevo para el mercado para reemplazar un medicamento de marca actualmente incluido en la farmacopea o agregar nuevas restricciones al medicamento de marca o moverlo a un nivel de costo compartido diferente, o ambas opciones. O podemos hacer cambios basados ​​en nuevas pautas clínicas. Si retiramos medicamentos de nuestra farmacopea, agregamos el requisito de autorización previa, límites de cantidad o restricciones de tratamiento escalonado sobre un medicamento o bien si movemos un medicamento a un nivel con costo compartido más alto, debemos notificar a los miembros afectados acerca del cambio al menos 30 días antes de que el cambio entre en vigencia o en el momento en que el miembro solicite resurtir el medicamento, cuando recibirá un suministro de 30 días del medicamento. Última actualización 09/01/2021 iii • Si realizamos estos otros cambios, usted o el profesional autorizado para recetar pueden solicitarnos que hagamos una excepción y sigamos cubriendo el medicamento de marca para usted. El aviso que le proporcionamos también incluirá información sobre cómo solicitar una excepción y, además, puede encontrar información en la página vi titulada “¿Cómo solicito una excepción a la farmacopea de ConnectiCare?” Cambios que no le afectarán si actualmente está tomando el medicamento. Generalmente, si usted está tomando un medicamento de nuestra farmacopea 2021 que estaba cubierto al comienzo del año, no discontinuaremos ni reduciremos la cobertura del medicamento durante el año de cobertura 2021, excepto como se describe en la página iii. Esto significa que estos medicamentos permanecerán disponibles con el mismo costo compartido y sin nuevas restricciones para aquellos miembros que los tomen durante el resto del año de cobertura. Este año no recibirá una notificación directa sobre los cambios que no le afecten. Sin embargo, el 1.º de enero del próximo año, esos cambios le afectarían y es importante que controle la lista de medicamentos del nuevo año del beneficio para ver los cambios en los medicamentos. La farmacopea adjunta se encuentra actualizada al 09/01/2021 . Para obtener información actualizada sobre los medicamentos cubiertos por nuestro plan, comuníquese con nosotros. Nuestra información de contacto aparece en la portada y contraportada. Nota: En el caso de un cambio en la farmacopea de mitad de año que no requiera mantenimiento, el cambio se agrega a una lista completa de los cambios que se han hecho desde que se imprimió la farmacopea. La lista de cambios se incluye en el folleto de la farmacopea que se envía por correo postal a los nuevos miembros con su kit de bienvenida. Los miembros existentes pueden ver la actualización de la farmacopea visitando nuestro sitio web en www.connecticare.com/medicare. La farmacopea publicada en nuestro sitio web se actualiza de forma mensual. Última actualización 09/01/2021 iv ¿Cómo debo usar la farmacopea? Hay dos formas de encontrar un medicamento dentro de la farmacopea: Condición médica La farmacopea empieza en la página 1. Los medicamentos de esta farmacopea se agrupan en categorías según el tipo de condición médica que tratan. Por ejemplo, los medicamentos utilizados para tratar una afección cardíaca se enumeran bajo la categoría “Medicamentos cardiovasculares-antihipertensivos/para lípidos”. Si sabe para qué se usa su medicamento, busque el nombre de la categoría de la lista que comienza en la página 1. Luego, busque su medicamento en el nombre de la categoría. Listado alfabético Si no está seguro de la categoría en la que debe buscar, busque su medicamento en el Índice que comienza en la página 95. El Índice proporciona una lista alfabética de todos los medicamentos incluidos en este documento. Tanto los medicamentos de marca como los medicamentos genéricos se enumeran en el Índice. Busque en el Índice para encontrar su medicamento. Junto a su medicamento, verá el número de página donde puede encontrar información sobre la cobertura. Busque la página que aparece en el Índice y encuentre el nombre de su medicamento en la primera columna de la lista. ¿Qué son los medicamentos genéricos? Nuestro plan cubre medicamentos de marca y medicamentos genéricos. Un medicamento genérico está aprobado por la Administración de Alimentos y Medicamentos (FDA) porque tiene el mismo ingrediente activo que el medicamento de marca. Generalmente, los medicamentos genéricos son menos costosos que los medicamentos de marca. ¿Se aplican restricciones a mi
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