Medicare Advantage

Prescription Drug Formulary (2014)

Rewards (HMO), Value (HMO) and Classic (HMO-POS) plans 

What is a Formulary?

A formulary is a list of covered drugs selected by a team of health care providers as a part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed.

Can the Formulary change?

Generally, if you are taking a drug on our current formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the current coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.

Formulary and pharmacies

 Comprehensive formulary — a complete list of covered drugs (Español coming soon)

 Drugs removed from 2014 Medicare Formulary

New! — Searchable formulary

 Participating pharmacies (Coming Soon) — listed in the provider/pharmacy directory

Mail order pharmacies

  • Health First Family Pharmacy
  • MedVantx — you must use MedVantx if you need your drugs shipped outside of Florida (by clicking this link you will be leaving Health First Health Plans' web site).

Forms

Prescription reimbursement form 

Requirements

Process for Part D prescription drug prior authorizations, exceptions, appeals and grievances

 Prior authorization requirements (MA-PD) 

Transition policy 

Medication Therapy Management, and drug and/or utilization management  

Utilization Management

Step therapy criteria 

Extra help for prescription drug costs

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
  • Your local Social Security office.
  • Your State Medicaid Office.

Assistance with Best Available Evidence for Low Income Subsidy 

Monthly plan premiums for people who get extra help from Medicare to help pay for their prescription drug costs.


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Last updated: 5/1/2014