FeelWell Pharmacy

AgeWell New York Medicare Part D Pharmacy Benefits

Your Medicare  Part D prescription drug plan rights including grievances, coverage determinations, exceptions and appeal processes are included in this section.  Please refer to your plan Evidence of Coverage, for more detailed information.

Envision Rx is the company AgeWell New York uses to manage members’ prescription drug coverage for Medicare.  You will see Envision Rx listed on your member ID card, In letters sent to you about your medicines and in the information listed below.

As an AgeWell New York member, you can call our pharmacy benefit manager,  Envision Rx Options, Inc., at 1-844-782-7670, 24 hours a day, 7 days a week, if you have any questions or concerns regarding pharmacy benefits,  picking up or paying for your prescription medicines at the pharmacy,  getting an emergency exception to our approved medicines list (formulary), obtaining information on the aggregate number of grievances, appeals, and exceptions filed with us, or any other questions about prescription medicines or medication supplies you may need.
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Medicare Formulary

A formulary is a list of prescription drugs (both generic and brand name) that are preferred by your health plan. Your health plan may only pay for medications that are on this “preferred” list, unless your health care provider talks with your health plan and gets prior approval.

View FeelWell Formulary

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Pharmacy Transition Policy

AgeWell New York wants to ensure your prescription drug transitions are safe and as easy to navigate. Please review the information below for guidance on any prescription drug transition.

Transition Fill Policy

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Pharmacy Exceptions and Coverage Determinations

If you require a medication that is not on the AgeWell New York formulary and you cannot use a formulary alternative, or if you require an exception to one of our utilization management rules or tiered cost sharing, you have the right to request a coverage determination. Review the information below to learn more.

Coverage Determination Form
Tier Exception Request Form
Non-Formulary Exception Request Form

Request for Reconsideration of Medicare Prescription Drug Denial

To may also initiate a coverage determination:

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Appoint a Representative

Appointment of Representative form (English)

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Pharmacy Appeals and Grievances

It is the policy of AgeWell New York to provide meaningful procedures for timely hearing and resolution of grievances. This policy enables us to use listening and problem-solving skills to resolve the issue presented. The policy also provides a protocol for escalation of grievances when warranted or requested.

As a member of AgeWell New York, you have the right to request an appeal to review an adverse coverage determination made by the AgeWell New York on the benefits that you believe you are entitled to receive

Learn more about Pharmacy Appeals and Grievances

Request for Reconsideration

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Pharmacy Traveling Out-of-Network & Submitting a Paper Claim

AgeWell New York wants to ensure you can access your prescription drugs when you are traveling. Please review the below for in depth information.

Pharmacy Traveling- out of network

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Pharmacy Best Available Evidence

What is best available evidence?

Federal regulations specify the requirements of Part D sponsors in the administration of the low-income subsidy program, including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, CMS systems do not reflect a beneficiary’s correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan. To address these situations, CMS created the best available evidence (BAE) policy. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary’s information is not accurate. Call us at (866)586-8044 if you are eligible for low income subsidy.

For more general information that is not specific to an individual plan, please view the following links: