Gulfcoast Pharmaceutical Specialty
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- Your Pharmacy Solution -
- Your Pharmacy Solution -
Q: Why would I receive a statement for full prices for medications if I already provided my insurance to the pharmacy?
A: One of the most common mistakes we encounter is either not being supplied with prescription drug insurance at the point of
admittance to the facility, or being supplied with the incorrect insurance card & info, i.e. the medical card, dental card, or Medicare Part A/B
(Red, White & Blue Card) which doesn't cover prescription drugs. If we do not have this at the point of admittance, we still need to supply the medications, otherwise the facility cannot uphold their obligation to provide patient care and pass medications. So we're in a tough spot, and most commonly neither the newly admitted resident nor a power of attorney or other responsible individual is available to provide us with the necessary information. If we do not receive the information we need, a statement will be generated.
Q: If I receive a billing statement for cash transactions because the pharmacy did not have the prescription insurance at the point of
admittance, can they bill the insurance retroactively?
A: Sometimes. Most insurances let us bill them retroactively 30-90 days, others longer. We will do everything we can to get you maximum
value from your prescription insurance, and credit you the difference on claims we've been able to re-bill retroactively.
Q: Why was my medication not covered by my prescription insurance?
A: Prescription insurances have formulary committees that make decisions as to what medications to cover, and what medications to not
cover. There are a multitude of factors involved, including therapeutic effectiveness, cost, availability over-the-counter, availability of substantially
more economical therapeutic equivalents, etc. For specific information, or to request a coverage determination from your prescription insurance,
we encourage you to contact them for their specific policies, we have no access to this information.
Q: Why were my medications filled twice in 1 month?
A: Sometimes it falls where your medications are filled at the beginning of the month (Between the 1st- 5th) and then again at the end of
the month (29th- 31st). Depending on your medication cycle, your medication is typically filled to last you 28-30 days. Most months have 30-31 days, therefore we refill your medications a few days prior to the last fill date. This allows for time for us to fill, package and deliver the medication to you before you run out of medication.
Q: Why is my statement Past Due if I made a payment?
A: The billing date for statements is always the last day of the month. If your payment was received AFTER the billing date, that payment
will not be reflected on the current statement.
Q: I chose to have my monthly invoice emailed, but I have not receive an email with my invoice?
A: Check your spam or junk folder in your email. Since we have the word "pharmacy" in our email address, many email providers flag our emails as spam. If the email is in your spam folder, you can mark it as "Not Spam" and it will go to your email inbox. Also, adding our email address to your contact list will also help our emails to get to your inbox. If you need us to re-send any emails, please let our billing department know and they will re-send the email.
Our Statement
Description and details on each part of the statement.
Click the image to enlarge.
Payment Options
For your convenience we offer several different payment options and also Auto Pay.
Click the image to enlarge.
ONLINE BILL PAY
ONLINE BILL PAY
Online payment now available for Patient's / Resident's Accounts. Click the PAY NOW button to pay your pharmacy bill online.
Download the Paysimple App and Make payments on the go!
Download the Paysimple App and Make payments on the go!
Click on the App Store or Google Play to get the App
Payment Options
Payment Options
• Automatic bank draft (Click Here for Automatic payment form)
• Automatic Debit or Credit card payment (Click Here for Automatic payment form)
**Instructions for Payment form Click Here
• Online payments at https://gpsspecialty.mypaysimple.com/s/payment-form
• Online payments at www.gpspharmacy.net (At the bottom of the Contact Us page)
• Or you can mail you check or money order to
GPS Pharmacy
P.O. Box 489 Gonzales, LA 70737
*Please be sure to include the patient’s name or pharmacy account number with all payments.
Payment Form
Payment Form
Click on form to open printable document
Payment Options
Payment Options
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Contact Our Billing Department
Contact Our Billing Department
If you have any questions about you billing statement, please don't hesitate to contact our billing department.
Medicare Part A, B, C & D
A Short Description of the Various Types of Medicare
Medicare Part A, B, C & D
A Short Description of the Various Types of Medicare
Medicare Part A (Hospital Insurance)
Medicare Part A (Hospital Insurance)
Coverage for medically necessary:
- Hospitalizations
- Home Health
- Skilled Nursing Care **Note: Skilled nursing care facilities often offer both “skilled care” and “intermediate care”
- If deemed to be in “Skilled Care,” Medicare Part A covers costs of all care, including prescription drugs.
- If deemed to be in “Intermediate Care,” Medicare Part D covers the cost of drugs, and payment for care delivered by the nursing facility is coordinated between the resident, their family, and the facility, and there are insurances available to assist with these costs.
This coverage is free if you have worked and paid FICA taxes for at least 40 calendar quarters (10 years). If you have not worked this long and paid FICA taxes, you will pay a monthly premium for this coverage. You or your loved one will have a card that looks like the one shown below, commonly referred to the “Red, White, and Blue Card.”
Medicare Part B (Medical Insurance)
Medicare Part B (Medical Insurance)
Coverage for medically necessary:
- Physician Services
- Outpatient services such as laboratory tests and X-rays.
- Durable Medical Equipment including Diabetic Testing Strips, Nebulizers, Wheelchairs and some Walkers, and Oxygen and associated Supplies.
- Some Vaccinations such as influenza and pneumococcal.
- Some special classes of medications, including nebulized medications, anti-organ rejection medications for those who have had a kidney or liver transplant, and some cancer medications.
The benefit requirements for Medicare Part B are the same as those illustrated for Part A, and both parts share a common card, as shown above.
Medicare Part C (Medicare Advantage Plans)
Medicare Part C (Medicare Advantage Plans)
- Medicare policy that allows private (commercial) health insurance companies to provide Medicare benefits.
- May be HMOs or PPOs
- Commonly referred to as Medicare Advantage plans (MA or MAPD)
- Medicare Advantage plans encompass and cover Medicare parts A, B, and D
Medicare Parts A and B will know if you or your loved one has enrolled in a Medicare Part C (Advantage Plan), and your Red, White, and Blue care will not work should you try to have a provider bill a claim for service provided to Medicare Part A or B.
Because there are multiple commercial providers of Medicare Advantage Plans, there is no universal card as in the case of Medicare Part A & B’s Red, White & Blue card. However, most plans have cards that appear as the example shown below, and will contain information for hospital providers, medical office providers, and pharmacies.
Medicare Part D (Prescription Drug Insurance)
Medicare Part D (Prescription Drug Insurance)
- Provides outpatients prescription drug coverage.
- Provided only through government-contracted private insurance companies, not directly by the government. However, the government regulates these companies and dictates how they do business.
Medicare Part D (Additional Info)
Medicare Part D (Additional Info)
As in the case of Medicare Part C plans, there are a number of Medicare Part D Plans available. Most cards appear similarly to this example card from Medco shown above, with pharmacy info only.
The Part D standard benefit, at a minimum, plan sponsors must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage known as the "Donut Hole." Sponsors may also offer plans that differ from – but are actuarially equivalent to – the standard benefit. Finally, they may also offer "enhanced" plans that provide benefits in addition to the standard benefit. Typically, the enhanced plans offer some coverage during the Donut Hole. The Standard Benefit is defined in terms of the benefit structure, not the drugs that must be covered under the
plan.
- In 2016, the Standard Benefit includes an initial Annual Deductible of $360 (the maximum allowed under law). This is called the Deductible Phase, or Stage 1.
- After meeting the deductible the beneficiary pays 25% of the next $2,950 ($737.50) in formulary drugs. This is called the Initial Coverage Period or Stage 2.
- Once the plan and the beneficiary have together paid the Initial Coverage Limit of $3,310 the beneficiary has a gap in coverage known as the "Donut Hole," or Stage 3.
- During the Donut Hole the beneficiary pays for the next $3,752.50 in formulary drugs. On brand name drugs the member receives a 50% manufacturer discount and a 5% “subsidy” from the plan. Therefore the member’s cost will be 45%. The member’s actual 2016 cost (45%) plus the 50% manufacturer subsidy (95%), counts toward TROOP. On generic drugs the member receives a 42% subsidy from Medicare. The member’s actual out-of-pocket cost (58%) counts toward TROOP.)
- Once the beneficiary has spent a total of $4850 ($360 + $737.50 + $3752.50) in "true out-of pocket costs" (TrOOP) in formulary drugs, he/she enters the Catastrophic Coverage Period, or Stage 4.
- During Stage 4 the beneficiary pays 5% of the cost for formulary drugs, or $2.95 for generics and $7.40 for brand name drugs, whichever is greater. Beneficiaries who meet the $4,850 out-of-pocket threshold remain in Stage 4 for the rest of the calendar year. The process begins over again the next year.
Medicare does not establish premium amounts for plans. Instead, premiums are established through an annual competitive bidding process and evaluated by CMS. Medicare does establish the maximum deductible amount, the Initial Coverage Limit, the TrOOP threshold and Catastrophic Coverage levels every year. The table below shows the standard benefit each year from 2010 – 2017. This table is subject to change, and the most current version is always available at http://www.medicareadvocacy.org/medicare-info/medicare-part-d/#standard%20benefit. We’ve included this information for you convenience on our website, but recommend visiting this website for the most current information.
Due to the complexity of Medicare, the best practice is to provide all your cards to your provider, your nursing facility, and your pharmacy, and be prepared to provide them in the event of hospitalization. Make copies of them for your loved ones should they be involved in your care.
Do not be afraid to engage your plan! Medicare is your benefit, and you pay for it, or have paid for it already while part of the workforce.
If you’ve received benefits such as physician care or prescription drugs, and the provider did not have the necessary information at the point of service, you may receive an invoice for the full cost of services. These costs can usually be dealt with retroactively, however best practice is to deal with them as soon as possible!
Standard Part D Benefit 2018-2019
Standard Part D Benefit 2018-2019
