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However, if the member’s renewal is received after adverse action but by the end of the renewal month during business hours, their current coverage will be reinstated for the following month and will be maintained until the renewal is processed. The member will be notified of the reinstatement. Example 1 Anne and Horace are a married couple enrolled in SeniorCare. January is the last month of their certification period, and their renewal is due on January 12. They do not submit the renewal by the due date. On January 17, a notice is sent to inform them that their SeniorCare coverage will end January 31 because they did not complete their renewal. Their renewal is received on January 31 during business hours. Anne and Horace’s SeniorCare coverage is reinstated for the month of February, and they are sent a notice that they are enrolled in SeniorCare effective February 1 and will remain enrolled while their renewal is being processed. On February 9, EMCAPO finishes processing the renewal and Anne and Horace remain eligible for SeniorCare. A new 12-month certification period is established beginning on March 1. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 33.16 SeniorCare Benefits 33.16.1 SeniorCare Benefits Introduction For all of the participation levels, SeniorCare allows the following: 1. The generic form of any covered prescription drug, unless the medical practitioner writes on the prescription that the brand name form of the covered prescription drug is medically necessary. 2. Insulins are the only general category of over-the-counter drugs that are covered. 3. For levels 1 and 2a all prescription drugs covered by Medicaid. Some limitations apply to prescription drug coverage for levels 2b and 3 if a rebate agreement has not been signed by the drug manufacturer. 4. Chemotherapy drugs that are FDA approved and the manufacturer has signed a rebate agreement. 5. Certain vaccines. For a list of covered vaccines, see SeniorCare Vaccines. Most prescriptions are limited to a 34-day supply of medication. There are a few classes of medications that are allowed to be filled as a three-month supply. Members should work with their pharmacist and prescriber to determine whether it is clinically appropriate to dispense a three-month supply. The co- payment amount is not affected by the number of days in the supply. Note Some drugs require prior approval from the SeniorCare program, called prior authorization.

Note The member should contact their provider to verify that SeniorCare covers a specific drug. SeniorCare does not cover the following: 1. Prescription drugs administered in a physician’s office. 2. Prescription drugs that are experimental or are for a cosmetic and not a medical purpose. 3. Over-the-counter drugs such as vitamins and aspirin, even with a prescription. 4. Prescription drugs for which authorization has been denied. 5. Prescription drugs from manufacturers who have not signed the appropriate rebate agreement;