Pharmacy Benefits and Programs

More Options. Lower Costs

Banner Medicare Advantage is committed to affordable, high quality health care. We know that high costs of medications and finding time to pick them up can result in patients not getting prescriptions filled and/or refilled. We’ve created robust prescription coverage benefits to help our members get the prescriptions they need when they need them affordably.

If you are enrolled in a Banner Medicare Advantage plan and have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Banner Medicare Advantage at no additional cost to you.

The MTM program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.

To take part in this program, you must meet certain criteria set forth in part by Medicare. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect your insurance benefits, co-pays, prescription coverage or available doctors or pharmacies.

To qualify for our MTM program, you must meet ALL of the following criteria: 

  • Have at least 3 of the following conditions or diseases: Chronic Heart Failure (CHF), Diabetes, Dyslipidemia, Hypertension, Asthma, Chronic Obstructive Pulmonary Disease (COPD), AND
  • Take at least 8 covered Part D medications that are chronic/maintenance medications, AND
  • Are likely to have medication costs of covered Part D medications greater than $4,696 per year.

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

  • Targeted Medication Review: At least quarterly, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor if we detect a potential problem.
  • Comprehensive Medication Review: At least once a year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. This review, or CMR, is provided to you confidentially via telephone by MedWiseRx, which provides this service on behalf of Banner Medicare Advantage. This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:
    • Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications.
    • Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

If you take many medications for more than one chronic health condition, call our Customer Care Center to see if you’re eligible for our MTM program. 

We’ve identified more than 35 commonly prescribed generic medications for complex and/or chronic medical conditions such as type 2 diabetes, high cholesterol and hypertension/high blood pressure to offer at $0 co-pay to Banner Medicare Advantage members.

Thanks to Banner Family Pharmacy, you don’t have to spend time going to the pharmacy and waiting on a line to pick up your prescriptions. For one co-payment, we’ll send a 90-day supply right to your home - no shipping charges. And, mail order co-payments are generally lower than the co-pay at a retail pharmacy. And, when you sign up for home delivery for select medications you routinely take (i.e. diabetes, high blood pressure medications), your first co-pay will be $0.

If you prefer to fill your prescriptions at a retail pharmacy in your community, we have an expansive list of participating pharmacies from which you can choose.

Medicare’s “Extra Help” Program is known as the Low Income Subsidy (LIS) Rider. If you qualify for extra help, you’ll get a LIS Rider or notice from Banner Medicare Advantage telling you how much help you’ll get next year towards your drug plan premium, deductible, and copayments.

As a member of Banner Medicare Advantage, you will receive the same coverage as someone who is not getting extra help. Your membership will not be affected by the extra help. This also means that you must follow all the rules and procedures in the Evidence of Coverage. You must also continue to pay your Medicare Part B premium.

Keep your notice with your Evidence of Coverage (EOC) booklet, so you can refer to it if you have questions about your costs. Medicare or Social Security will periodically review your eligibility to make sure that you still qualify for extra help with your Medicare prescription drug plan costs. Your eligibility for extra help might change if there is a change in your income or resources, if you get married or become single, or you lose Medicaid. You will be notified if your status changes.

If you have any questions about your LIS Rider, please contact our Customer Care Center.

Banner Medicare Advantage Prime
LIS Premium Summary     English | Español

Banner Medicare Advantage Plus
LIS Premium Summary     English | Español

Banner Medicare Advantage Dual
LIS Premium Summary     English | Español