SilverScript Medicare Drug Plan / Part D Prescription Drug Coverage
What Is SilverScript?
SilverScript is a Medicare Part D drug plan by the SilverScript Insurance Company. The SilverScript Insurance Company is part of CVS Health, the parent company of the CVS/Caremark pharmacy chain. SilverScript has contracted with the Centers for Medicare & Medicaid Services since 2006 to provide Medicare Part D stand-alone prescription drug coverage.
SilverScript claims to have over 3,250 drugs on its formulary, i.e. its list of covered medications for enrollees. Enrollees in SilverScript receive a complimentary ExtraCare Health Card. This card is provided free with no extra cost. The ExtraCare Health Card can be used to save money on purchases made at CVS/pharmacy stores.
SilverScript offers two main plans: SilverScript Choice (PDP) and SilverScript Plus (PDP).
SilverScript Choice (PDP)
The SilverScript Choice plan has a $0 drug deductible. Consequently, enrollees receive cost-sharing from the insurance plan from the beginning of coverage rather than after the deductible is satisfied.
SilverScript Plus (PDP)
The SilverScript Plus plan is designed for Medicare enrollees who take multiple medications and, therefore, have a higher likelihood of entering the "donut hole" (otherwise known as the "Coverage Gap"). SilverScript Plus offers improved insurance coverage of costs for Tier 1 medications purchased in the Coverage Gap period than the SilverScript Choice plan.
CMS Sanction in 2013
SilverScript was temporarily sanctioned in 2013 by the Centers for Medicare & Medicaid Services (CMS) and prohibited from enrolling new members in its prescription drug program as well as marketing for this program. In the document provided by CMS, the government outlined the issue and its resolution:
On January 15, 2013, the Centers for Medicare & Medicaid Services (CMS) imposed intermediate sanctions on SilverScript Insurance Company (SSIC), thereby suspending SSIC’s marketing and enrollment activities for its standalone Prescription Drug Program (PDP) contract, S5601. CMS’s decision was based on SSIC’s serious deficiencies in the following operational areas: enrollment operations, claims adjudication, and low income subsidy (LIS) administration.
Pursuant to CMS’s request, and in accordance with 42 CFR § 423.756(c)(3)(i), SSIC hired an independent auditor to assess SSIC’s enrollment operations and provide CMS with information to verify that the deficiencies that were the basis for the sanctions have been corrected and are not likely to recur. On November 25, 2013, CMS received your attestation stating that the deficiencies which were the basis for the sanctions were corrected and not likely to recur. In addition to reviewing the independent assessment, CMS has reviewed various enrollment files and enrollee record submissions, as well as complaints from SSIC members captured in the CMS Complaint Tracking Module (CTM).
In consideration of this extensive review, and additional information and assurances from SSIC, CMS has determined that SSIC’s deficiencies have been corrected and are not likely to recur. Therefore, effective January 1, 2014, CMS is releasing the sanctions and SSIC may begin marketing to beneficiaries. Additionally, SSIC may begin enrolling beneficiaries with effective dates beginning February 1, 2014.