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Prescription Medications

CarolinaCARE is the prescription service and specialty medication pharmacy for the Atrium Health Navicent Plans. Health Plan members access CarolinaCARE for Affordable Care Act (ACA) medications, preventive medications, maintenance and specialty medications.  

Retail Pharmacy is any pharmacy outside of CarolinaCARE.

  • Maximum of one fill allowed at retail for maintenance medications on the ACA and Preventive Drug Lists for the Basic Plan. Plan then requires transition to CarolinaCARE, or member will pay full cost, which will not apply to the deductible or annual out-of-pocket expense.  
  • Copays apply after deductible is met for the Choice Plan.     
  • Opioid prescriptions are limited to 30-day quantity by law.  
  • Specialty drugs are filled at CarolinaCARE only. Some exceptions may apply to drugs in limited distribution. 
  • Specialty drug copays may vary with use of manufacturer coupons and copay assistance programs.    

It is recommended you evaluate your current medications and possible need for future medications and review the formulary to determine cost/tier at CarolinaCareRx.org > Get My Rx Price. If you have a chronic medical condition or take at least one medication on a daily basis, you can make an appointment and review your medication history with a pharmacist at One-on-One Rx. Visit CarolinaCareRx.org.  

CarolinaCARE Prescription Refill Programs 

CarolinaCARE now offers two convenient prescription refill programs. You can sign-up to enroll in either one: 

  • MyQuik Rx Refill Reminders 
    Receive an automated e-mail reminder about prescriptions eligible for refill within a 2-week timeframe. Then place the Rx order for home delivery through the CarolinaCARE website or by phone at 866-697-6800 – all at your convenience. 

  • MyQuik Rx Automatic Refills 
    You can select specific prescriptions to be automatically refilled, invoiced and shipped to you at the time they become due for processing and on an on-going basis.  

To enroll, please loin to the CarolinaCARE website, read and accept the Terms and Conditions for your preferred refill program.  

Please do not select Specialty medication for automatic refills if your specialty drug is managed by Atrium Health Specialty Pharmacy Services. The specialty team will continue to contact you each month about refills for these specific medications.

Important Notice about Your Prescription Drug Coverage

TO ACTIVE EMPLOYEES OR COBRA PARTICIPANTS ELIGIBLE FOR MEDICAL COVERAGE AS OF JANUARY 1, 2022  
If you are Medicare eligible (or if you or your dependents are Medicare eligible or will be in the near future) — and you participate in Atrium Health Navicent (the “Company”) medical coverage — this notice applies to you. Since we may not know if your dependents are Medicare eligible, we are sending this notice to all employees and COBRA participants who are eligible for Atrium Health Navicent's medical coverage.  

In this letter and in the notice that follows, Atrium Health Navicent's medical coverage also are referred to as “Company-sponsored coverage.” Please disregard this information if it does not apply to you.   

CarolinaCARE Prescription Mail Service

The mail service pharmacy reduces your out-of-pocket expenses and the time you spend ordering and picking up prescriptions by allowing you to receive up to a 90-day supply of your medication. All prescription mail delivery services are administered by CarolinaCARE.

Creditable Coverage Notice  
Please read this notice carefully and keep it where you can find it. The notice has information about your current prescription drug coverage with Atrium Health Navicent and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area.  

Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:  

 

  1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.  
  2. Atrium Health Navicent has determined that the prescription drug coverage offered by the Atrium Health Navicent medical plans is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.  

 

WHEN CAN YOU JOIN A MEDICARE DRUG PLAN?  
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 through December 7. However, if you lose your current creditable prescription drug coverage through no fault of your own, you also will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.   

WHAT HAPPENS TO YOUR CURRENT COVERAGE IF YOU DECIDE TO JOIN A MEDICARE DRUG PLAN?  
If you decide to join a Medicare drug plan, your current Atrium Health Navicent coverage will not be affected. Your current Company-sponsored coverage pays for other health expenses, in addition to prescription drugs, and you will still be eligible to receive all of your current health and prescription drug benefits if you choose to enroll in a Medicare prescription drug plan. However, if you drop your Company-sponsored coverage, be aware that you and your dependents may not be able to get this coverage back.   

WHEN WILL YOU PAY A HIGHER PREMIUM (PENALTY) TO JOIN A MEDICARE DRUG PLAN?  
You should also know that if you drop or lose your current coverage with Atrium Health Navicent and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.   

FOR MORE INFORMATION ABOUT THIS NOTICE OR YOUR CURRENT PRESCRIPTION DRUG COVERAGE ...  
Contact Atrium Health Navicent's Benefits Service Center at 1-800-964-4780 for information about your company sponsored coverage. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if the coverage through Atrium Health Navicent changes. You also may request a copy of this notice at any time.   

FOR MORE INFORMATION ABOUT YOUR OPTIONS UNDER MEDICARE PRESCRIPTION DRUG COVERAGE...  
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: 

  1. Visit medicare.gov.  
  2. Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.  
  3. Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.  
  4. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at ssa.gov or call them at 1-800-772-1213 (TTY 1-800-325-0778).  
     
    Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).  

Discrimination is Against the Law
Atrium Health Navicent complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, gender identity, sexual orientation, pregnancy, or genetic information.
Atrium Health Navicent:

  1. Provides free aids and services to people with disabilities to communicate effectively with us, such as: Video Interpreting, Qualified sign language interpreters, Written information in other formats (large print, audio, accessible electronic formats, other formats) 
  2. Provides free language services to people whose primary language is not English, such as: Video Interpreting, Qualified interpreters, Information written in other languages

  3. If you need these services, contact Jan Cranford, Language Interpretation Coordinator, Atrium Health Navicent. 478-633-6868  

    If you believe that Atrium Health Navicent has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: the Privacy Officer, Atrium Health Navicent, 777 Hemlock Street, MSC 92, Macon, Georgia 31201. Phone: 478-633-2164. Fax: 478-633-5378. Email: richard.jones@atriumhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance the Privacy Officer is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20211, 1–800–868–1019, 800–537–7697 (TDD).  

Complaint forms are available at hhs.gov/ocr/office/file/index.html.