2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN . If you use a mail-order pharmacy that is not in the plan's network, your prescription will not be covered. For more recent information or other questions, please For complete terms of use visit Out-of-network/non-contracted providers are under no obligation to treat Independence Blue Cross Medicare members, except in emergency situations. HPMS Approved Formulary File Submission ID 19529, Version Number 29 . Please call the To request a reimbursement specifically for a vaccine and/or a vaccine administration fee, please use the For the Influenza Vaccine Reimbursement Form, please see the Your benefit includes the option to receive prescription drugs shipped to your home through our network mail-order delivery program.Pharmacies are required to obtain consent prior to shipping or delivering any prescriptions that the beneficiary did not personally initiate. For more recent information or other questions, please contact Aetna Medicare Member Services at 1-800-594-9390 0000000016 00000 n
This formulary was updated on 09/01/2020. 0000004049 00000 n
Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.The formulary, pharmacy network, and/or provider network may change at any time. Our plan's mail-order service allows you to order up to a 90-day supply for certain prescriptions. Any rate change will apply to all policies in our service area and cannot be changed or canceled because of poor health. A formulary is a list of covered medications. Your copay is the same for anything between a 31-90 day supply at mail order. When this drug list (formulary) refers to “we,” “us,” or “our,” it means Simply Healthcare Plans. This list of drugs is carefully selected by the plan with the help of a team of doctors and pharmacists, and is reviewed and approved by Medicare. For an up-to-date list of covered drugs or if you have questions, please call UnitedHealthcare Customer Service. 2020 UCare Medicare and EssentiaCare Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. Get detailed information on your Medicare Advantage and Medicare Part-D plan's drug cost in your area.
For more recent information or other questions, please
0000013705 00000 n
This list of drugs is carefully selected by the plan with the help of a team of doctors and pharmacists, and is reviewed and approved by Medicare. MDLIVE does not guarantee patients will receive a prescription.
We will consider your request and make a coverage decision. 0000001211 00000 n
When that happens, you will have to pay the full cost of your prescription. 2020 Medicare Advantage Formulary Reference Guide Anticoagulants Class Drug Tier DTI PradaxaQL 4 Factor Xa-I Eliquis, XareltoQL 3 Fondaparinux 2.5mg 4 Fondaparinux (5mg, 7.5mg, 10mg) 5 LMWH Enoxaparin 4 VKA Jantoven, Warfarin 1 Coumadin 4 Antipsychotics Class Drug Tier Atypical Olanzapine QL Tab, QuetiapineQL IR, Risperidone IR/PO Soln 2 For an updated formulary… 0000016447 00000 n
Usually a mail-order pharmacy order will get to you in no more than 14 days. 2019 Comprehensive Formulary Aetna Medicare (List of Covered Drugs) GRP B2 Plus 3 Tier PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. For more recent information or other questions, please 2019 FORMULARY (LIST OF COVERED DRUGS) FHCP Medicare Rx (HMO) FHCP Medicare Rx Plus (HMO-POS) FHCP Medicare Rx Savings (HMO) FHCP Medicare Premier Plus (HMO) FHCP Medicare Flagler Advantage (HMO) This formulary was updated on 11/19/2019. MDLIVE may not be available in certain states and is subject to state regulations. Applicants NOT enrolling during the six-month open enrollment period or in a guaranteed issue situation will be evaluated for tobacco usage and charged the corresponding tobacco or non-tobacco rates. Get detailed information on your Medicare Advantage and Medicare Part-D plan's drug cost in your area. 2020 UCare Medicare and EssentiaCare Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. 0000003710 00000 n
When it refers to “plan” or “our plan,” it means Simply Care (HMO SNP). This formulary was updated on 10/01/2018. 0000005139 00000 n
Plan F and Plan N are available only to applicants who enroll within six months following enrollment in Medicare Part B or who are guaranteed the right to purchase these plans under applicable federal or state laws.
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.