What are the opioid policies for 2021?

Opioid drugs have serious risks such as addiction, overdose and death. CMS is very concerned about the opioid epidemic and its effect on our communities and is committed to a complete strategy to combat this public health emergency. For 2021, several drug management programs are in place to prevent and combat opioid overuse:

• Opioid prescriptions will be monitored for safe dosage levels. If one or more opioid prescription is above a safe dosage limit, the prescription will be stopped at the pharmacy for review by the provider to make sure that the prescription is medically necessary and appropriate. 
• Opioid prescriptions that are taken together with benzodiazepine prescriptions will be stopped at the pharmacy for review by the provider to make sure that the prescriptions are medically necessary and appropriate. 
• Members who have not had a recent prescription for opioids will be limited to no more than a seven-day supply for their first opioid prescription for the treatment of acute pain. 
• Prescriptions for Long-Acting Opioids that are taken at the same time will be stopped at the pharmacy for review by the provider to make sure that the prescriptions are medically necessary and appropriate.  
  
  

You may be exempt from these drug management programs if you

• Have an active cancer diagnosis
• Have a diagnosis of sickle cell anemia
• Are in a hospice or long-term care facility
  
  

For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY: 711), seven days a week, 8 a.m. – 8 p.m.

You may also contact your provider with any medication related questions.

Do I have to enroll in a Medicare prescription drug plan?
You don’t have to enroll in Medicare Part D. However, even if you’re not currently taking many prescription drugs, you should still consider joining a plan, so if things change, you’ll have the coverage you need. If you wait to enroll in a Medicare prescription drug plan, you may have to pay a penalty for joining late.

What if I didn’t join a Medicare Prescription Drug plan when they were first offered?
If you didn’t sign up for a plan by May 15, 2006, and you don’t have a drug plan that covers as much or more than a Medicare prescription drug plan, you may have to pay more each month.

Can I enroll in a stand-alone Medicare prescription drug plan, if Geisinger Gold’s Medicare plan already includes prescription drug coverage, along with the medical coverage (an MA-PD plan)?
No. If you purchase a stand-alone Medicare drug plan while you're enrolled in a Medicare Advantage plan with prescription drug coverage (MAPD), you'll be automatically disenrolled from the MAPD plan.

If I enroll between Oct. 15 and Dec. 7, 2020, when will my coverage become effective?
Your coverage will become effective on Jan. 1, 2021.

Where can I see what drugs are covered?

View 2021 Drug Plan Formularies

• Geisinger Gold Standard Rx (Secure Rx) Medicare Prescription Drug Plan Comprehensive Formulary (updated June 10, 2021/effective June 1, 2021)
• Geisinger Gold $0 Deductible Rx Medicare Prescription Drug Plans Comprehensive Formulary (updated June 10, 2021/effective June 1, 2021)

Where can I find in-network pharmacies?

Our pharmacy network includes nearly 3,000 retail pharmacies, both large chain pharmacies and neighborhood drug stores, throughout Pennsylvania. Geisinger Gold has contracts with pharmacies that meet or exceed CMS requirements for pharmacy access in your area.

Find a pharmacy near you

Is there additional information?

Learn more about exceptions and appeals regarding your prescription coverage.

If you purchase a stand-alone Medicare drug plan while you're enrolled in a Medicare Advantage plan with prescription drug coverage (MAPD), you'll be automatically disenrolled from the MAPD plan.

Members must get their prescriptions from network pharmacies. In case of emergency, members may go to a non-network pharmacy. You may only enroll in one prescription drug plan at a time. If you are enrolled in a Medicare Advantage plan which offers prescription drug coverage, you must take your prescription drug coverage from that plan. You cannot enroll in a stand-alone prescription drug plan unless you disenroll from your Medicare Advantage plan. If you are enrolled in a Medical Savings Account plan you can enroll in a stand-alone prescription drug plan. Prescription drug coverage from Geisinger Gold is offered exclusively to Geisinger Gold members.

Geisinger Gold may add or remove drugs from our formulary during the year. For more information, contact the Pharmacy Service Team at 800-988-4861, seven days a week, 8 a.m. – 8 p.m., or 711 (TTY/TDD), seven days a week, 8 a.m. – 8 p.m.

If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a different tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

Geisinger Gold covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call

• 1-800-MEDICARE (800-633-4227) TTY users should call 877-486-2048, 24 hours a day/7 days a week
• The Social Security Office at 800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 800-325-0778
• Your state Medicaid office

When will I receive my Geisinger Gold insurance card?
You'll receive your card after Medicare and Geisinger Gold confirm your eligibility; the timeframe for this varies.

Should I cancel my current insurance?
No, you should never cancel any existing insurance until you have received verification of acceptance with another plan. You may also be required to put that in writing for your current insurer.

When will I get the first bill? Can I change my payment method if I get a bill and then want it deducted from my checking/savings/credit card account?
That depends on the billing cycle and when Medicare's approval is received. In most cases, the first bill (if not electronically deducted from a savings/checking/credit card or Social Security check) will be a double bill until the billing cycle puts it in a routine mailing. You can make arrangements with the customer care team to have your premiums deducted from a checking/savings/credit card.

Will I be enrolled right away?
The application needs to be verified by Medicare. Please wait until you receive your confirmation letter to cancel any current coverage.

If I enroll between Oct. 15 and Dec. 7, 2020, when will my coverage become effective?
Your coverage will become effective on Jan. 1, 2021.

Where do I mail an enrollment application?
A pre-printed envelope was provided with your application. If it's not available, mail the application to:
Geisinger Gold
Attn. Enrollment 32-29
P.O. Box 900
Danville, PA 17821-9979

For the emergency contact, should I list someone who doesn’t live with me?
That’s your choice. A lot of people choose the spouse; however, some choose an adult child outside of the home. Sometimes they even choose a friend. Note that the application contains space for only one contact/telephone number.

Where can I find the "PCP Number" requested on the Gold application?
You can use our online Provider Search tool to see if your primary care physician (PCP) is available with Geisinger Gold. You will find the PCP Number next to each doctor’s name in the search results. You can also contact Geisinger Gold at 800-498-9731, Monday - Friday, 8 a.m. - 8 p.m., for assistance.

What is the State Pharmaceutical Assistance Program and how do I apply?
Pennsylvania’s State Pharmaceutical Assistance Programs, called PACE and PACENET, work with both Medicare and Geisinger Gold to ensure eligible Pennsylvanians have quality drug coverage at the lowest possible cost.  To speak with a PACE/PACENET representative, call toll-free at 866-712-2060 Monday - Friday, 9 a.m. - 5 p.m. You can also contact Geisinger Gold at 800-498-9731, Monday - Friday, 8 a.m. - 8 p.m., for assistance. TTY users should call 711.