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At Clever Care, we put members’ health and safety first. As part of our Medicare Part D plan, Clever Care offers QA and UM programs at no extra cost to Part D members. These programs are designed to ensure the safe and appropriate use of prescription medications covered under Medicare Part D. The programs help identify potential risks and opportunities to improve your medication therapy.
This program consists of three parts, and is designed to encourage the safe, appropriate, and cost-effective use of Medicare Part D prescription drugs.
Prior authorization (PA)
A PA requirement means the member, or their doctor must get approval before your medication is covered at your pharmacy.
Step therapy (ST)
A ST requirement means you must first try one drug to treat a medical condition before another drug will be covered for that same condition.
Quantity limits (QL)
A Quantity Limit requirement limits the amount of a drug that will be covered with prior approval.
Together, these programs help us identify and work to resolve any health and safety risks that your medications could pose, and to help you get the most benefit from your Medicare Part D plan.
Clever Care of Golden State is an HMO and HMO C-SNP plan with a Medicare contract. Enrollment in Clever Care of Golden State depends on contract renewal.
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