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WellCare

Certificate Training Aid

TermDefinition
2021 PDP Plan Highlights 6 plans across every state and DC, 204 total nationwide Designed to limit premium increases 3 competitive formularies (formally was 4) SSM (reducing member costs on insulin)
SSM (New) ? Part D Senior Savings Model (SSM) - reduces member spending on insulin
Who is eligible for SSM? Non-low income enrollees + members using insulin
What benefits are provided under SSM? Caps cost-sharing to no more than $35 per month supply per year + plan deductible (if any) does not apply
Will all of the WellCare PDP plans include SSM? No, so far 3 PDP products, 102 plans will participate in all regions (Value Script, Wellness Rx, Value Plus) + cost-sharing cap $35 per year
Will all of the WellCare MAPD plans include SSM? NO, 22 Legacy plans in select regions + offered first to plans already offering insulin gap coverage + cost-sharing range $0-$35
LIS Category 0 member needs no assistance and is considered a "base member"
LIS Category 3 indicates highest need member
LIS Category 4 used to assign a co-pay and Part D premium subsidy (subsidy varies 25-100%)
What is the preferred pharmacy? preferred cost-sharing through CVS Caremark Home Delivery, otherwise it will cost more (see table on desktop) + Walgreens (and most grocers, for 5/6 plans)
Created by: cmazzariti
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