Get prescription drug information - HMO-POS plans
New this year, insulin coverage.
For all Rx plans, you pay $35 for a 1-month supply of eligible insulin products in the Deductible, Initial Coverage and Coverage Gap stages. Select “View 2021 formulary,” choose “Antidiabetic Agents” then “Insulins.” All eligible insulins will be designated with an SI graphic in the Notes & Restrictions column.
How are my prescription drugs covered?
Get the most value out of your pharmacy benefit by understanding the formulary for your health insurance plan. A formulary is a list of drugs that are covered by your plan. Look up your prescriptions and learn what tier your drugs are in. The tier tells you how much you will have to pay for your prescription.
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What's a formulary?
A formulary is a list of drugs covered by your plan. -
What's your formulary used for?
Use the formulary to look up your prescriptions to see what tier they are on, quantity limits, prior authorization requirements or if they are covered by Part B. -
What's a drug tier?
A tier tells you how much you will have to pay for your prescriptions.
Other Part D information
Low Income
Subsidy Extra help from Medicare for your drug costs and premiums
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan. This table shows you what your monthly plan premium will be if you get extra help.
| Your level of extra help | Monthly Premium for Spirit Rx* | Monthly Premium for Essence Rx* | Monthly Premium for Ascend Rx* | Monthly Premium for Promise Rx* | Monthly Premium for Esteem Rx/Assurance Rx/Surety Rx* |
|---|---|---|---|---|---|
| 100% | $185.30 | $44.30 | $0.00 | $32.30 | $0 |
| 75% | $195.50 | $54.50 | $10.00 | $42.50 | $0 |
| 50% | $205.60 | $64.60 | $20.00 | $52.60 | $0 |
| 25% | $215.80 | $74.80 | $30.00 | $62.80 | $0 |
* This does not included any Medicare Part B premium you may have to pay. It also does not include the $34 dental premium if you selected the optional supplemental dental benefit.
Self-help tools
Web access and tools to provide drug pricing transparency, alternative drugs, history of drug claims and side effect information.
Opioid management
Resources
Part D Drug Reimbursement Request formPart D Vaccine Reimbursement Request form
2021 Medicare HMO-POS Comprehensive formulary
2021 Medicare HMO-POS Prior Authorization formulary
2020 Medicare HMO-POS formulary
2020 Medicare HMO-POS Comprehensive formulary
2020 Medicare HMO-POS Prior Authorization formulary
MedImpact Direct - Medication Mail Order Form
Drug Transition Policy
Pharmacy Locator
Drug Safety News
New rules for pain medications