With the DaVita VillageHealth, members receive both medical and prescription drug benefits in one convenient plan. This means you have one ID Card for both your medical and prescription drug benefits!

As an ESRD beneficiary, you likely take a variety of medications on a daily basis. Nationally, it is estimated that the average ESRD patient takes between 7 and 14 different medications daily. Under the Medicare Part D coverage, DaVita VillageHealth may be able to help you reduce your prescription drug costs substantially as well as guard against improper drug combinations or protocols that uniquely affect individuals with ESRD.

In addition, a DaVita VillageHealth Pharmacist will consult with you to ensure you understand what each medication you take is for, monitor the various drugs you take to identify improper combinations or dosages, and, for your safety, communicate with your various providers regarding the prescriptions you take.

The DaVita VillageHealth Medicare Part D drug benefit:

Type of Prescription Drug	What You Pay for In- Network:*	What You Pay for Out of Network:*
Annual Deductible	$275
Generic Drugs	$6 Copay per 31-day supply**	$6 Copay per 10-day supply
Preferred Brand Drugs	$30 Copay per 31-day supply**	$30 Copay per 10-day supply
Brand Name Drugs	$55 Copay per 31-day supply**	$55 Copay per 10-day supply
Specialty Drugs	25% Coinsurance
Once total drug spend reaches $2,510	You pay 100% until your yearly out-of-pocket drug costs reach $4,050.
After total drug spend reaches $5,600	You pay the greater of $2.25 for generic or $5.60 for all other drugs, or 5% Coinsurance

*If you are eligible for Medicaid, the state may be required to cover Medicare cost-sharing that you would otherwise be required to pay. These amounts may differ based on what level of Medicaid coverage you have.

**You may receive up to a 90 day supply of routine, maintenance medications. The copay for a 90 day supply is 3 times the amount stated above.

For more details on the Medicare Part D Prescription Drug benefit, please:

View or download a copy of the Summary of Benefits
View or download a copy of the Evidence of Coverage

Mail Order Benefit

In addition to the retail pharmacy benefit described above, DaVita VillageHealth provides benefits for mail order pharmacy. Under this benefit, you can have your prescription medications delivered right to your door!

Under the mail order benefit, you pay:

Type of Prescription Drug	What You Pay:
Formulary Generic drug	$12 for a three month/90 day supply
Formulary Preferred Brand Drugs	$60 for a three month/90 day supply
Formulary Brand Drugs	$110 for a three month/90 day supply

You should allow up to 2 weeks for the processing and delivery of your medication order.

For more information on the mail order benefit, click here to view or download a Home Delivery Brochure.

Extra Help with Drug Costs

You may qualify for extra help with your Medicare prescription plan costs. This help may reduce your out-of-pocket costs or eliminate them entirely, depending on your income level. When you join DaVita VillageHealth, Medicare will tell us how much extra help you are getting. Then we will let you know the amount you will pay.

If you are not getting this extra help, you can see if you qualify by calling 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048. You can call this number 24 hours a day, 7 days a week.

Formulary (List of Covered Drugs)

A formulary is a list of drugs selected by DaVita VillageHealth that have been proven to be a necessary part of a quality treatment program for ESRD and related conditions as well as those medications standardly included in plan formularies. The formulary consists of Generic, Preferred Brand, Brand name, and Specialty drugs.

View or download a copy of the DaVita VillageHealth Formulary

DaVita VillageHealth may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If any change is made to the formulary that directly impacts you, you will be given 60 days advance notice.

If you are currently taking a medication not included in our formulary, you may be able to get a temporary or transition supply of the drug to give you time to discuss with your physician an alternative formulary drug. You can also contact us to request an exception if you and your physician do not feel that changing your medication is an alternative that will work for you.

To learn about your rights in requesting an exception or appeal on a medication request, please refer to Section 10 of the Evidence of Coverage or the Appeals and Grievance Section of this website.

View or download a copy of the Evidence of Coverage

CMS also provides you with tools to determine if the drugs you are currently taking are covered under the DaVita VillageHealth Plan. The Medicare Prescription Drug Plan Finder (MPPF) contains a list of the formulary drugs covered by DaVita VillageHealth.

Access the Medicare Prescription Drug Plan Finder (MPPF).

Access the RX America Prior Authorization Criteria report here

Disclaimer

If you have questions or would like to enroll, call 866-838-1962, 8 a.m. to 8 p.m., 7 days a week. TTY users should dial 711. The standard Medicare Part D prescription drug plan is available to all members for their use only. Benefits, copayments, coinsurance and premiums may change on January 1, 2009. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Eligible beneficiaries must use network pharmacies to access their prescription drug benefits except under non-routine circumstances when they cannot reasonably use network pharmacies. Other limitations or exclusions may apply.