Part D Client Resources – HTA Insurance Services

Prescription Drug Plan Client Resources

Create your Online Account

Most questions about your prescription drug plan can be answered instantly by logging into your carrier’s member portal.

We strongly recommend you create and use your online account with your Part D carrier. Inside your account, you can:

Obtain your ID Card
Check drug prices in real time
View your deductible and coverage stage
See claims and billing details
Confirm your payment method
Look up pharmacies and pricing differences

If you need help setting this up, our office is happy to guide you.

Part D Carrier Contact Information

Carrier	Member Services Phone	Member Portal
Aetna/SilverScript	844-979-3435	Aetna Member Portal
Cigna/HealthSpring	800-668-3813	Cigna/HealthSpring Portal
Highmark	800-241-5704	Highmark Member Portal
Humana	800-457-4708	Humana Member Portal
Unitedhealthcare	888-867-5575	UHC Member Portal
Wellcare	888-550-5252	Wellcare Member Portal

Frequently Asked Questions

Pricing & Costs

What is my deductible?
Your deductible is the amount you must pay out-of-pocket before your plan begins covering certain medications.

Not all drugs are subject to the deductible

Many plans have $0 deductible on Tier 1 & Tier 2 drugs

The easiest way to check your deductible is through your online member portal, where you can:

See if your plan has a deductible

Track how much you’ve already paid toward it

View your current coverage stage in real time
How are my drug costs calculated?
Your prescription costs can change during the year depending on how much you and your plan have already paid for your medications.

The easiest way to think about it is in 3 simple stages:

Deductible Stage
At the beginning of your plan, you may pay the full cost of your prescriptions until you meet your deductible (if your plan has one).

Coverage Stage
After that, your plan starts helping. You’ll pay a set copay or a percentage of the cost, and the plan covers the rest.

$0 Cost Stage (Catastrophic Coverage)

Once your out-of-pocket prescription costs reaches $2,100 in 2026, you’ll pay $0 for covered medications for the rest of the year.

What counts toward that $2,100 limit?

Your deductible (what you paid up front)

Your copays and coinsurance for covered prescriptions

What does NOT count?

Your monthly plan premium

Medications that aren’t covered by your plan

How to keep track:
The easiest way to know where you stand is by checking your member portal. It shows:

How much you’ve spent so far

Which stage you’re in

What each of your medications will cost
Why did my medication cost change between refills?
It is common for out-of-pocket costs to fluctuate throughout the year for several reasons:

Coverage Stages: Your costs change as you move through the Deductible, Initial Coverage, and Catastrophic stages. For example, in 2026, once your out-of-pocket spending hits $2,100, your cost for covered drugs drops to $0 for the rest of the year.

Pharmacy Networks: Prices often differ depending on whether you use a preferred or standard pharmacy within your plan’s network.

Annual Plan Updates: Each January, plans update their “formulary” (list of covered drugs) and tier structures, which can change a medication from a $0 copay to a higher cost-share.

Manufacturer Pricing: Changes in the negotiated price between the drug manufacturer and your insurance carrier can affect your coinsurance.
Why is my medication cheaper at one pharmacy than another?
Most Part D plans use Preferred vs. Standard pharmacies.

Preferred Pharmacies: Lower negotiated copays

Standard Pharmacies: May have higher out-of-pocket costs

Even though both are in-network, pricing can vary.

Use your carrier’s “Find a Pharmacy” or pricing tool in your member portal to compare costs before filling your prescription.
Can I use GoodRx instead of my Part D plan?
Yes—you can choose to use GoodRx instead of your Part D plan for a prescription.

However, there are a few important things to understand:

You cannot use both at the same time—it’s one or the other

Purchases made with GoodRx do NOT count toward your deductible or out-of-pocket spending

Sometimes GoodRx may offer a lower price, especially for certain generic medications

Before filling your prescription, it’s a good idea to:

Check your price using your Part D plan (through your member portal)

Compare it to the GoodRx price

Ask your pharmacist to compare both options for you

Coverage & Approvals

What is a Prior Authorization?
A prior authorization means your insurance needs approval before it will pay for a medication.

Your doctor sends information to the insurance company

The insurance company reviews it before deciding if it will be covered

This is usually done to make sure the medication is necessary and the right option for you.
How do I get a "Formulary Exception"?
If your medication isn’t covered, you can ask your plan to make an exception.

Your doctor will need to send a request to your insurance

They’ll explain why other covered medications won’t work for you

Your insurance company will review the request and decide

Where do I get the form?
You can find the formulary exception request form:

In your member portal

On your plan’s website (often under “Forms” or “Coverage Determinations”)

Or by calling your Part D plan and asking them to send it to you

You can give this form to your doctor’s office—they will usually complete and submit it for you.
I have a new medication. How is it covered?
Before going to the pharmacy, log into your member portal and use the “Price a Medication” tool.

This will show:

If the drug is covered (on the formulary)

What tier it is on

Your estimated cost

Any requirements (prior authorization, step therapy, or quantity limits)

This is the best way to avoid unexpected costs at the pharmacy.

Billing & Account

How can I view my billing history or change my payment method?
You can manage your billing through your carrier’s online member portal, where you can:

View your premium payment method (Social Security deduction, bank draft, or card)

Update payment information

Review claims and Explanation of Benefits (EOBs)

See exactly what was charged and why

Getting Help

Who should I contact if i still need help?
Due to recent changes with Prescription Drug Plans, insurance carriers now require members to work directly with them for most servicing needs. This means we’re not able to access your plan details or make changes on your behalf.

For the fastest and most accurate assistance, contact your Part D plan directly.

You can:

Log into your carrier’s member portal, or

Call the phone number on the back of your ID card