Rights and Responsibilities as a Member
As a member of the Plan you have certain rights and responsibilities.
As a plan member, you have the right to:
- Access prescription drugs at network pharmacies regardless of race, national origin, religion, physical handicap, or source of payment.
- Receive prescription medication.
- File a grievance, coverage determination, and/or appeal. Grievance, Coverage Determination and Appeals procedures are in effect at all times.
- Be treated with dignity, respect, and right to privacy.
- Receive information about the plan.
As a plan member, you have the responsibility to:
- Use the pharmacy network except in emergencies.
- Notify Granite Alliance and Social Security Office in writing of any address/telephone number changes if you move, even if only a temporary move.
Granite Alliance Insurance Company is a prescription drug plan with a Medicare contract. You may submit feedback about your Medicare plan on Medicare's website or by contacting the Medicare Ombudsman.
Quality Assurance Policies and Procedures
How does Granite Alliance conduct drug utilization reviews and ensure quality prescriptions for Medicare Part D members?
We conduct drug utilization reviews for all of our members to make sure that you are receiving safe and appropriate care. These reviews are especially important for members who have more than one doctor who prescribe their medications. We conduct drug utilization reviews each time you fill a prescription and on a regular basis by reviewing our records. During these reviews, we look for medication problems such as:
- Possible medication errors
- Duplicate drugs that are unnecessary because you are taking another drug to treat the same medical condition
- Drugs that are inappropriate because of your age or gender
- Possible harmful interactions between drugs you are taking
- Drug allergies
- Drug dosage errors
If we identify a medication problem during our drug utilization review, we will work with your doctor to correct the problem.
Potential for Contract Termination
Our plan is required to notify beneficiaries that it is authorized by law to refuse to renew its contract with the Centers for Medicare & Medicaid Services (CMS), that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment. In addition, the plan may reduce its service area and no longer offer services in the area where you reside. In the event this happens, you will receive advance notice.