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HealthSpring Prescription Drug Plan-Reg 15 (S5932-014-0)
Tier 1 (1893)
Tier 2 (1142)


Requires Prior Authorization:
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Uses Step Therapy:
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2010 Medicare Part D Plan Formulary Information
HealthSpring Prescription Drug Plan-Reg 15 (S5932-014-0)
Benefit Details  
The HealthSpring Prescription Drug Plan-Reg 15 (S5932-014-0)
Formulary Drugs Starting with the Letter V

in CMS PDP Region 15 which includes: IN KY
Drugs Starting with Letter V

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
VALCYTE 450MG TABLET   2 Tier 2 25%25%None
VALPROATE SOD 500MG/5ML VL   1 Tier 1 25%25%None
VALPROIC ACID 250MG CAPSULE   1 Tier 1 25%25%None
VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT   1 Tier 1 25%25%None
VALTREX 1GM CAPLET (90 CT)   2 Tier 2 25%25%None
VALTREX 500MG TABLET   2 Tier 2 25%25%None
VANACET 5/500 TABLET   1 Tier 1 25%25%Q:240
/30Days
VANCOCIN HCL 125MG PULVULE   2 Tier 2 25%25%None
VANCOCIN HCL 250MG PULVULE   2 Tier 2 25%25%None
VANCOMYCIN HCL 10GM VIAL   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
VANDAZOLE 0.75% GEL WITH APPLICATOR   1 Tier 1 25%25%None
VAQTA 25 UNITS/0.5ML VIAL   2 Tier 2 25%25%P
VARIVAX VACCINE W/DILUENT   2 Tier 2 25%25%P
VECTICAL OINTMENT 3MCG/GM 100 GM TUBE   2 Tier 2 25%25%None
VEETIDS 125MG/5ML ORAL SUSP   1 Tier 1 25%25%None
VEETIDS 250MG TABLET   1 Tier 1 25%25%None
VEETIDS 500MG TABLET   1 Tier 1 25%25%None
VELCADE 3.5MG VIAL   2 Tier 2 25%25%P
VELIVET TABLET TRIPHASIC 28 (7BEIGE+7ORANGE+7PINK)   1 Tier 1 25%25%None
VENLAFAXINE HCL 100MG TABLET   1 Tier 1 25%25%Q:120
/30Days
VENLAFAXINE HCL 25MG TABLET   1 Tier 1 25%25%Q:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
VENLAFAXINE HCL 37.5MG TABLET   1 Tier 1 25%25%Q:120
/30Days
VENLAFAXINE HCL 50MG TABLET   1 Tier 1 25%25%Q:120
/30Days
VENLAFAXINE HCL 75MG TABLET   1 Tier 1 25%25%Q:120
/30Days
VENLAFAXINE HCL ER TAB   1 Tier 1 25%25%Q:30
/30Days
VENLAFAXINE HCL ER TAB 225 MG   1 Tier 1 25%25%Q:30
/30Days
VENLAFAXINE HCL ER TAB 37.5 MG   1 Tier 1 25%25%Q:30
/30Days
VENLAFAXINE HCL ER TAB 75 MG   1 Tier 1 25%25%Q:30
/30Days
VENTOLIN HFA 90MCG INHALER   2 Tier 2 25%25%Q:36
/30Days
VERAPAMIL 120MG CAP PELLET   1 Tier 1 25%25%None
VERAPAMIL 120MG TABLET SA   1 Tier 1 25%25%None
VERAPAMIL 180MG CAP PELLET   1 Tier 1 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
VERAPAMIL 2.5MG/ML AMPUL   1 Tier 1 25%25%None
VERAPAMIL 240MG CAP PELLET   1 Tier 1 25%25%None
VERAPAMIL 40MG TABLET   1 Tier 1 25%25%None
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS   1 Tier 1 25%25%None
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT)   1 Tier 1 25%25%None
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS   1 Tier 1 25%25%None
VERAPAMIL HCL 120MG TABLET   1 Tier 1 25%25%None
VERAPAMIL HCL 18OMG ER TABLET   1 Tier 1 25%25%None
VERAPAMIL HCL 240MG TABLET SA   1 Tier 1 25%25%None
VERAPAMIL HCL 80MG TABLET   1 Tier 1 25%25%None
VESICARE 10MG TABLET   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
VESICARE 5MG TABLET (90 CT)   2 Tier 2 25%25%None
VFEND 200MG TABLET   2 Tier 2 25%25%P
VFEND 40MG/ML SUSPENSION   2 Tier 2 25%25%P
VFEND 50MG TABLET   2 Tier 2 25%25%P
VFEND IV 200MG VIAL   2 Tier 2 25%25%P
VICODIN HP TABLET 10-660   1 Tier 1 25%25%Q:180
/30Days
VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU   2 Tier 2 25%25%P
VIDEX 2GM PEDIATRIC TUBEX   2 Tier 2 25%25%None
VIGAMOX 0.5% EYE DROPS   2 Tier 2 25%25%None
VIMPAT INJECTION 10MG/ML 10 X 20ML VIALGL   2 Tier 2 25%25%P
VIMPAT TABLETS 100MG 60 BOTPL   2 Tier 2 25%25%P Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
VIMPAT TABLETS 150MG 60 BOTPL   2 Tier 2 25%25%P Q:60
/30Days
VIMPAT TABLETS 200MG 60 BOTPL   2 Tier 2 25%25%P Q:90
/30Days
VIMPAT TABLETS 50MG 60 BOTPL   2 Tier 2 25%25%P Q:60
/30Days
VINBLASTINE SULF 10MG VIAL   2 Tier 2 25%25%P
VINCRISTINE 1MG/ML VIAL   1 Tier 1 25%25%P
VINCRISTINE 1MG/ML VIAL   1 Tier 1 25%25%P
VINORELBINE 10MG/ML VIAL 5ML VIAL   1 Tier 1 25%25%P
VIOKASE 16 TABLET   2 Tier 2 25%25%None
VIOKASE POWDER   2 Tier 2 25%25%None
VIRACEPT 250MG TABLET   2 Tier 2 25%25%None
VIRACEPT 50MG/GM ORAL POWDER   2 Tier 2 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
VIRACEPT 625MG TABLET   2 Tier 2 25%25%None
VIRAMUNE 200MG TABLET   2 Tier 2 25%25%None
VIRAMUNE 50MG/5ML SUSP   2 Tier 2 25%25%None
VIREAD 300MG TABLET   2 Tier 2 25%25%None
VISTIDE 75MG/ML VIAL   2 Tier 2 25%25%None
VIVAGLOBIN SOL 160MG/ML 10ML VIAL   2 Tier 2 25%25%P
VIVOTIF BERNA 2B UNIT CAPSULE DELAYED RELEASE   2 Tier 2 25%25%None
VYTORIN 10/10MG TABLET (1000 CT)   2 Tier 2 25%25%Q:30
/30Days
VYTORIN 10/20MG TABLET (1000 CT)   2 Tier 2 25%25%Q:30
/30Days
VYTORIN 10/40MG TABLET (500 CT)   2 Tier 2 25%25%Q:30
/30Days
VYTORIN 10/80MG TABLET 2500 BOT   2 Tier 2 25%25%Q:30
/30Days

Chart Legend:

Below are a few notes to help you understand the above 2010 Medicare Part D HealthSpring Prescription Drug Plan-Reg 15 Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the the standard $310 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons wit the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2830) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2010 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.