Sonder Health Plans is committed to protecting the health of our Members and providing timely services. As such, we follow all CMS guidelines for providing benefits during a disaster or public health emergency declaration.
We’ve compiled a list of Georgia approved vaccination sites within Cobb, Gwinnett, Dekalb and Fulton counties. You can download this list below.
Relax the “refill-too-soon” edits if circumstances are reasonably expected to result in a disruption in access to drugs at the point-of-sale. Health Plans may also allow an affected enrollee to obtain the maximum extended day supply available under their plan, if requested and available.
Consistent with §423.124(a) of the Part D regulations, Health Plans are required to ensure enrollees have adequate access to covered Part D drugs dispensed at out-of-network pharmacies when those enrollees cannot reasonably obtain covered Part D drugs at a network pharmacy. Enrollees remain responsible for any cost sharing under their plan and additional charges (i.e., the out-of-network pharmacy’s usual and customary charge), if any, that exceed the plan allowance.
In situations when a disaster or emergency makes it difficult for enrollees to get to a retail pharmacy, or enrollees are actually prohibited from going to a retail pharmacy (e.g., in a quarantine situation), Health Plans will relax any plan-imposed policies that may discourage certain methods of delivery, such as mail or home delivery, for retail pharmacies that choose to offer these delivery services in these instances. Prior Authorization for Part D Drugs: Health Plans may choose to waive prior authorization requirements at any time that they otherwise would apply to Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified. Any such waiver must be uniformly provided to similarly situated enrollees who are affected by the disaster or emergency.
Health Plans may choose to waive prior authorization requirements at any time that they otherwise would apply to Part D drugs used to treat or prevent COVID-19, if or when such drugs are identified. Any such waiver must be uniformly provided to similarly situated enrollees who are affected by the disaster or emergency.
Health Plans will follow the existing drug shortage guidance in Section 50.13 of Chapter 5 of the Part D manual in response to any shortages that result from this emergency.
Under current law, if a vaccine becomes available for COVID-19, Medicare will cover the vaccine. Health Plans will be required to cover the vaccine if it is a Part D drug.
These special requirements are in effect until the end date identified in the Public Health State of Emergency, State Declaration, or other applicable regulatory requirement or order; if no end date is identified by State or Federal orders, Sonder Health Plans will apply a 30 days end date.
For questions regarding services already rendered, claims, contracts, etc., please contact your Provider Relations Representative or send an email to: providerrelations@sonderhealthplans.com.
If you require immediate assistance, contact Provider Services team at 1-888-216-5210.