Pharmacy Changes for iCare Family Care Partnership Members who Enrolled in Medicaid only and are not Eligible for Medicare. The purpose of this notice is to let you know about changes to your Medicaid pharmacy benefit starting January 1, 2020. Currently, Independent Care Health Plan (iCare) provides your pharmacy benefit. Starting January 1, 2020, your Partnership pharmacy benefit will be provided directly by the state Medicaid program, known as ForwardHealth. The ForwardHealth pharmacy benefit is similar to your current pharmacy benefit with iCare. This change applies to your pharmacy benefits only. iCare will still provide your other medical and long-term care benefits. Please read this entire notice to understand what this change means for you. If you have questions, please contact your care team at 1-800-777-4376 (TTY: 711).

Prior Authorization Prescription Drugs requiring prior authorization by Wisconsin Medicaid may be different from the Prescription Drugs that required prior authorization by iCare. If you are taking a drug that requires prior authorization by Wisconsin Medicaid, your doctor completes the prior authorization request. If your prior authorization request is denied by Wisconsin Medicaid, you can work with your doctor or pharmacist to get a different drug or you can appeal the denial. You will receive a letter from Medicaid with information on how to appeal. Wisconsin Medicaid wants to make sure you get the drugs you need. If you try to fill a prescription and your pharmacist cannot fill it because of these changes, please ask your pharmacist for an emergency supply. Your pharmacist may be able to give you up to a 14-day emergency supply of the drug. Once you get the emergency supply, you should ask your doctor and pharmacy to work on submitting a prior authorization. Only one emergency supply fill may be available per drug.

Copayments for Drugs From January 1, 2020 – June 30, 2020, there will be no copays for your medications. Starting July 1, 2020, you may be required to pay a copayment to the pharmacy to help pay for the cost of the drug.

• $3 for brand name drugs. • $1 for generic and compound drugs. • 50 cents for over-the-counter drugs. If you are not able to pay the copayment right away, the pharmacy will still give you your drug and bill you for the copayment later. If you get all your prescriptions filled at one pharmacy, the most you will have to pay in copayments in one month will be $12. However, the $12 does not include copayments for over-the-counter drugs.

Identification Cards Remember to show your identification card each time you visit your pharmacy. You may have one or more of the following identification cards: • ForwardHealth card. • Other commercial health insurance cards.

Please bring all of your cards to your pharmacy so your pharmacist can tell you which card or cards are needed to fill your prescription. Other Information

• All Medicaid members need a ForwardHealth card. If you do not have one, please call Member Services toll free at 1-800-362-3002 and ask for a new card.

• If you have questions or concerns, please call your iCare care team at

1-800-777-4376 (TTY: 711) or Member Services toll free at 1-800-362-3002.

• If you are currently prescribed an OTC medication, it may now be covered with your Forward Health benefit. If the OTC is not covered, please present the included sticker attached on your Forward Health card to your pharmacy so they can bill select OTC medications through iCare directly. Please contact you IDT if this occurs prior to your next scheduled refill.

• Please note this change effects every Partnership member that is not eligible for Medicare, regardless of the MCO they are enrolled.