Wisconsin Medicare Prescription Drug Plans

Questions? Call 1-800-731-0459 (TTY: 711)

PDP Customer FAQs


Do I need to create an account?

To enroll online, you will need to create your own customer account. This will allow you to save and return to your enrollment.

I’m already a PDP customer. How do I access my plan details?

If you’re already a WPS customer, make sure you’re getting the most from your plan online! You have access to online pharmacy services. Be sure to register to take advantage of the following features:

  • Refill and renew prescriptions online
  • Review up to 18 months of your prescription history
  • Compare prescription coverage and price
  • Find lower-cost alternatives to your current medications
  • And much more!
When can I enroll?

If you're currently entitled to Medicare Part A and/or enrolled in Medicare Part B, permanently reside in Wisconsin, and you are a U.S. citizen or are lawfully present in the United States, you can sign up during the Annual Enrollment Period that runs from Oct. 15 to Dec. 7 each year. Your WPS MedicareRx Plan (PDP) coverage will begin Jan. 1.

If you are eligible, but miss the Dec. 7 deadline, you may have to wait until the next Annual Enrollment Period to join a plan. Also, unless you have creditable prescription drug coverage—coverage that is at least as good as the standard Medicare prescription drug coverage—you may receive a late-enrollment penalty.

Here are some of the times outside of the Annual Enrollment Period when you may sign up:

  • You turn 65: You can sign up during the three months before your birthday, the month of your birthday, and the three months after.
  • You lose or terminate creditable prescription drug coverage through your employer or union.
  • You get Medicare due to a disability.
  • You receive full Medicaid coverage.

For more information, give us a call or contact your local insurance agent.

How do I enroll?

Enrolling is easy and takes only a few minutes.

Hours of Operation:

8 a.m. to 8 p.m., weekdays (year-round) and weekends (Oct. 1–March 31).

Enroll by mail or fax: Download the 2019 WPS MedicareRx Plan Enrollment Form.

Mail your enrollment form to:
WPS Health Insurance
Attn: Member Services—PDP Enrollment
P.O. Box 8190
Madison, WI 53708-8190

Fax your enrollment form to: 1-608-243-6154

Do I have to enroll in a PDP?

A Medicare prescription drug plan is an option, not a requirement. You do not have to enroll in Medicare Part D. However, even if you do not take many prescription drugs now, you may want to enroll in a plan so you’ll have it if you need prescription drug coverage in the future.

You may owe a late-enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:

  • A Medicare prescription drug plan (Part D)
  • A Medicare Advantage plan (Part C), which is similar to an HMO or PPO
  • Another Medicare health plan that offers Medicare prescription drug coverage
  • Creditable prescription drug coverage
What is the service area?

The service area for the WPS prescription drug plan includes Wisconsin. However, our networks include pharmacies in all 50 states. You must live in Wisconsin to join this plan. As a WPS MedicareRx Plan customer, you have access to more than 65,000 retail network pharmacies, as well as convenient and safe mail-order delivery through an advanced mail-order pharmacy.

How are network pharmacies selected?

This plan has contracts with pharmacies that equal, or exceed, Centers for Medicare & Medicaid Services (CMS) requirements for pharmacy access in your area. In most cases, your prescriptions are covered under this plan only if they are filled at a retail network pharmacy or through our mail-order pharmacy. We will fill prescriptions at out-of-network pharmacies under certain circumstances. Quantity limitations and restrictions may apply.

Long-term care and home infusion pharmacies may serve a broad area. Therefore, you may need to look outside your immediate area for these types of providers.

What pharmacies can I use?

The pharmacies listed in our online look-up directory are the most current. Inclusion in this list does not guarantee a pharmacy continues to participate in your plan's network. To get current information about WPS MedicareRx Plans network pharmacies in your area, call Customer Service at 1-800-688-1604 (TTY: 1-800-716-3231) 24 hours a day, seven days a week.

WPS has been serving the people of Wisconsin since 1946, so you can rest assured knowing pharmacies across Wisconsin are used to working with us. The WPS MedicareRx Plan card is accepted at thousands of chain and independent pharmacies across the U.S.

For more information, give us a call or contact your local insurance agent.

Can I use an out-of-network pharmacy?

In most cases, your prescriptions are covered under this plan only if they are filled at a retail network pharmacy or through our mail-order pharmacy. Covered Part D drugs are available at out-of-network pharmacies in special circumstances, including illness while traveling outside the plan's service area where there is no retail network pharmacy. You may incur an additional cost for prescriptions filled at an out-of-network pharmacy. Please note the pharmacies in our network now may change later.

Can I use mail-order service?

For added savings, use our convenient mail-order service to fill your prescriptions and have them delivered right to your door with free shipping. You won't have to wait in line or drive to the pharmacy, saving you time and money.

WPS MedicareRx Plan 1 and Plan 2 customers can get a 90-day supply of medication for the cost of two and a half times the 30-day copay when they use our preferred mail order pharmacy. Note the 90-day supply option is not covered for specialty drugs on Tier 5.

Order your refills by phone, mail, or online, knowing pharmacists can answer your questions 24 hours a day, seven days a week. Your order will usually ship within 10-15 days of the pharmacy receiving the order. If your order does not arrive within 10 days, please call Customer Service at 1-800-688-1604 (TTY: 1-800-716-3231), 24 hours a day, seven days a week.

What's more, prescriptions are automatically checked for possible drug interactions, including those filled at your local pharmacy. You can be confident you’ll get the right medication in the right amount.

Do I have to use mail-order service?

You are not required to use mail-order service. If you decide not to use our mail-order service, you will not be eligible to get a 90-day supply of medication for the cost of two and a half times the 30-day copay as you would if you used our mail-order service.

Can I get a 90-day supply at the pharmacy?

You can get a 90-day supply of medication at the pharmacy. However, if you fill a 90-day supply at the pharmacy, you will pay the full 90-day copay.

To get a 90-day supply of medication for the cost of two and a half times the 30-day copay, you must use our convenient mail-order service.

Can I get extra help paying for the plan and my medications?

If you qualify for extra help with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join WPS MedicareRx Plan (PDP), 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 contacting:

  • 1-800-MEDICARE (1-800-633-4227, TTY: 1-877-486-2048), 24 hours a day/seven days a week
  • The Social Security Office at 1-800-772-1213 (TTY: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday
  • Your State Medicaid Office
What is Medication Therapy Management (MTM)?

The Medication Therapy Management (MTM) program is available at no extra cost for customers with multiple health conditions who take multiple medicines. The MTM program helps you and your doctor make sure your medicines are working to improve your health.

MTM is offered through our partnership with Express Scripts, Inc. and SinfoniaRx. The MTM program is not considered a part of the plan’s benefit.

How does MTM help me?

If you qualify for the MTM program, you will be contacted and have the chance to speak with a highly trained pharmacist or a pharmacist intern who is under the direct guidance of a pharmacist. During that call, the pharmacist or pharmacist intern will complete a comprehensive medication review of your medicines and talk with you about:

  • Any questions or concerns about your prescription or over-the-counter medicines, such as drug safety and cost
  • Better understanding your medicines and how to take them
  • How to get the most benefit from your medicines

For more information, give us a call or contact your local insurance agent.

 

This page last modified Wednesday, 05-Dec-2018 13:06:13 CST

Call today for a free info kit!

Contact your local agent or call us at 1-800-731-0459 (TTY: 711)
8 a.m.-8 p.m., weekdays (year-round) and weekends (Oct. 1—March 31).