Get the free RXtra Prescription Drug Benefit Summary

This document outlines the prescription drug benefits provided by Providence Health Plan, including copayment amounts, covered drugs, limitations, exclusions, and procedures for utilizing the pharmacy

How to fill out rxtra prescription drug benefit

How to fill out RXtra Prescription Drug Benefit Summary

1. Obtain the RXtra Prescription Drug Benefit Summary form from your pharmacy or healthcare provider.
2. Fill out your personal information, including name, address, and contact details at the top of the form.
3. Provide your insurance information, including the policy number and the name of your insurance provider.
4. List all prescribed medications, including the name of each drug, dosage, and frequency as instructed by your healthcare provider.
5. Check the coverage section to ensure all listed medications are covered under the RXtra plan.
6. Fill in any additional required information, such as allergies or other health conditions if prompted.
7. Review the completed form for accuracy before submitting it to the pharmacy or your healthcare provider.
8. Keep a copy of the submitted form for your records.

Who needs RXtra Prescription Drug Benefit Summary?

1. Individuals who regularly take prescription medications and want to track their benefit coverage.
2. Patients transitioning to a new prescription plan or who have recently had a change in insurance.
3. Caregivers managing medications for someone else who requires a summary of their prescription benefits.
4. Anyone interested in understanding their medication costs and insurance coverage for better financial planning.

People Also Ask about

What is the extra help on prescription drugs?

The Extra Help program helps people with limited income and resources lower or cut Part D costs. Medicare Part D provides drug coverage. The Extra Help program helps with the cost of your prescription drugs, like deductibles and copays. You can apply for Extra Help any time before or after you enroll in Part D.

What is the M3P payment for Medicare?

The Medicare Prescription Payment Plan (sometimes referred to as the M3P or MPPP) is a new payment option that will be available to anyone with a Medicare Advantage plan with drug coverage.

How much is the new Medicare payment?

Medicare Part B (Medical Insurance): The standard Part B monthly premium in 2025 is $185. Most beneficiaries pay this amount. The Part B deductible is $257 per year. Part B coinsurance—the share you're expected to pay after reaching your deductible—is 20% of the cost for each Medicare-approved service or item.

What is a prescription summary of benefits?

Your prescription drug Explanation of Benefits (EOB) statement shows a summary of your past medication orders. It is not a bill. Express Scripts records your prescription claim on an EOB statement each time you get a prescription filled at a retail network pharmacy or through home delivery.

What is the M3P for Medicare?

This will be beneficial for patients with Medicare Part D who have high out of pocket costs earlier in the plan year by spreading out those expenses over the course of the year. CMS named this program the Medicare Prescription Payment Plan or M3P and it was created as part of the Inflation Reduction Act of 2022.

For pdfFiller’s FAQs

What is RXtra Prescription Drug Benefit Summary?

RXtra Prescription Drug Benefit Summary is a document that provides an overview of the prescription drug benefits offered to members under a specific insurance plan.

Who is required to file RXtra Prescription Drug Benefit Summary?

Insurance providers and employers offering prescription drug benefits are required to file the RXtra Prescription Drug Benefit Summary to ensure compliance with regulatory requirements.

How to fill out RXtra Prescription Drug Benefit Summary?

To fill out the RXtra Prescription Drug Benefit Summary, individuals should gather necessary information about the prescription drug coverage, including plan details, covered medications, and any cost-sharing requirements, and input them into the designated sections of the summary form.

What is the purpose of RXtra Prescription Drug Benefit Summary?

The purpose of the RXtra Prescription Drug Benefit Summary is to inform members about their prescription drug coverage, including the benefits, limitations, and costs associated with their medication plans.

What information must be reported on RXtra Prescription Drug Benefit Summary?

The RXtra Prescription Drug Benefit Summary must report essential information such as the plan name, covered drugs, exclusions, copay amounts, deductible information, and any special program details related to medication management.