Prescription Drug Benefits

Drug Coverage


  • Our 2017 List Of Covered Drugs (PDF) (Formulary) shows the Part D drugs covered by IMCare Classic (HMO SNP).
  • Our online search feature lets you see if specific Medicare Part D drugs are covered by IMCare Classic (HMO SNP).
  • The list of Medical Assistance (Medicaid)-covered, Part D-excluded drugs tells you which drugs are covered under your Medical Assistance (Medicaid) benefit.
  • Our Over-the-Counter drug list tells you which of these drugs are covered by IMCare Classic (HMO SNP) under your Medical Assistance (Medicaid) benefit. The items on the list are covered when you have a prescription from your health care provider or pharmacist.
  • If the drug you are taking is not on the list of covered drugs, read your MSHO Member Handbook (PDF) (Evidence of Coverage) to find out what you can do. This includes instructions for both new and current members.
  • If you would like help managing your prescription drugs, read about our Medication Therapy Management Program (PDF) and its eligibility requirements. You can also see a sample of the Personal Medication List (PDF).

Restrictions on Covered Drugs


Some drugs have restrictions on coverage. Read about drug restrictions in your MSHO Member Handbook (PDF) (Evidence of Coverage). You can also learn more about each of our drug restriction programs by looking at the:

Exceptions/Coverage Determinations


You may ask for an exception to the drug coverage and restriction rules by doing any of the following, fill out the Itasca Medical Care Formulary Exception (PDF). Note: this form must be completed by a health care provider. Completed forms can be mailed or faxed:

Mail


IMCare Classic
Attn: Medicare Appeals Department
1219 SE 2nd Avenue
Grand Rapids, MN 55744-3983

Fax


218-327-5545

Call Member Services at 800-843-9536. TTY users can call 800-627-3529 or 711. Calls to these numbers are free. Hours are:
  • October 1 to February 14
    7 days a week 8 a.m. - 8 p.m.
  • February 15th - September 30th
    Monday - Friday 8 a.m. - 8 p.m.
  • If you contact us, we may need to get more information from your prescribing health care provider. If you need help or have questions, call Member Services.

Transition Period Drug Benefits


Read our Transition Period Drug Benefit Policy to learn about your benefits during a transition period.

Questions/Complaints About Prescription Drug Coverage


If you have a complaint about your prescription drug coverage (e.g., if your drug will not be covered, has restrictions that you don't agree with, or if you think your copay is too high), you can do any of the following:
  • Read about "coverage decisions" and "Appeals" in your MSHO Member Handbook (PDF) (Evidence of Coverage).
  • Contact IMCare Classic's Member Services at 218-327-6188 or toll free 800-843-9536.
  • Tell Medicare about your complaint by visiting the Centers for Medicare and Medicaid Services (CMS) website. You may also call Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY/TTD users can call 877-486-2048. Calls to these numbers are free.
  • Ask someone to help you file a complaint. Someone you choose may file a complaint (Grievance) or Appeal for you. The person you name would be your "appointed representative." You may name a relative, friend, lawyer, advocate, health care provider, or anyone else to act for you. Other people may already be authorized by the Court or under State law to act for you. If you want someone to act for you who is not already authorized by the Court or State law, then you and that person must sign and date a statement that gives the person legal permission to be your representative. You may call Member Services to learn how to name your appointed representative. You may also fill out the Appointment of Representative Form (PDF). Once you have filled out the form, you should print it and mail or fax it to Itasca Medical Care:

Mail


IMCare Classic
Attn: Medicare Appeals Department
1219 SE 2nd Avenue
Grand Rapids, MN 55744-3983

Fax


218-327-5545

Reimbursement


We cannot pay you back for most medical bills that you pay. State and Federal laws prevent us from paying you directly. The exception is if you pay for Part D prescription drugs. If you paid for a drug that you think we should have covered, call Member Services at 800-843-9536. TTY users can call 800-627-3529 or 711. Calls to these numbers are free. Hours are:
  • October 1 - February 14
    7 days a week 8 a.m. - 8 p.m.
  • February 15 - September 30
    Monday - Friday 8 a.m. - 8 p.m.
  • Or, you can print a Medicare Prescription Drug Claim Form (PDF) and follow the instructions to complete and submit it to us for review.

H2417 IMCARECLASSIC_114 CMS_Approved 04/04/2017
​Last Updated_04/05/2017