Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community


2011 Medicare Part D and Medicare Advantage Plan Formulary Browser

Select your search style and criteria below or use this example to get started

Search by:
State & Plan   ZIP & Plan   PlanID   FormularyID

Search Criteria
PDP     MAPD
Scroll down to see formulary results.

Health Net Orange Option 1 (PDP) (S5678-056-0)
Tier 1 (1401)
Tier 2 (633)
Tier 3 (558)
Tier 4 (668)
Tier 5 (286)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2011 Medicare Part D Plan Formulary Information
Health Net Orange Option 1 (PDP) (S5678-056-0)
Sanctioned Plan           
The Health Net Orange Option 1 (PDP) (S5678-056-0)
Formulary Drugs Starting with the Letter P

in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
Drugs Starting with Letter P

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
PACERONE 200MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PACLITAXEL INJECTION SOLUTION 6MG 50ML VIALMD   4 Tier 4 Injectable 25%25%None
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA]   4 Tier 4 Injectable 25%25%None
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA]   4 Tier 4 Injectable 25%25%Q:1
/28Days
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA]   4 Tier 4 Injectable 25%25%Q:1
/28Days
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA]   4 Tier 4 Injectable 25%25%Q:1
/28Days
PALIPERIDONE PALMITATE 156 MG/ML PREFILLED SYRINGE [INVEGA]   4 Tier 4 Injectable 25%25%Q:2
/28Days
PAMIDRONATE 60MG/10ML VIAL   4 Tier 4 Injectable 25%25%None
PAMIDRONATE DISODIUM INJECTION 3MG 10ML VIALSD   4 Tier 4 Injectable 25%25%None
PAMIDRONATE DISODIUM INJECTION 9MG 10ML VIALSD   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PANITUMUMAB 20 MG/ML INJECTABLE SOLUTION [VECTIBIX]   5 Tier 5 Specialty 25%25%P
PANRETIN 0.1% GEL 60GM TUBE   5 Tier 5 Specialty 25%25%P
PANTOPRAZOLE SODIUM 20MG TABLET DELAYED RELEASE   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PANTOPRAZOLE SODIUM 40MG TABLET DELAYED RELEASE 90 CRC BOT   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PARCAINE 0.5% DROPS   1 Tier 1 Preferred Generic $4.00$8.00None
PAROMOMYCIN 250MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00None
PAROXETINE 40MG TABLET (500 CT)   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PAROXETINE FILM COATED 20MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PAROXETINE HCL 10MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PAROXETINE HCL 10MG/5ML SUSPENSION ORAL   1 Tier 1 Preferred Generic $4.00$8.00Q:30
/1Days
PAROXETINE HCL TABLET 24 12.5MG   1 Tier 1 Preferred Generic $4.00$8.00Q:3
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PAROXETINE HCL TABLET 24 25MG   1 Tier 1 Preferred Generic $4.00$8.00Q:3
/1Days
PAROXETINE TABLETS 30MG 90 BOT   1 Tier 1 Preferred Generic $4.00$8.00Q:2
/1Days
PASER GRANULES 4GM PACKET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PATADAY 0.2% DROPS   2 Tier 2 Preferred Brand $37.00$74.00None
PATANOL 0.1% EYE DROPS   2 Tier 2 Preferred Brand $37.00$74.00S
PAZOPANIB 200 MG ORAL TABLET [VOTRIENT]   5 Tier 5 Specialty 25%25%P
PEDI-DRI TOPICAL POWDER   1 Tier 1 Preferred Generic $4.00$8.00None
PEDIARIX SOLUTION INJECTION 25-25-10 10 X .5ML VIAL   4 Tier 4 Injectable 25%25%None
PEDVAXHIB VACCINE VIAL   4 Tier 4 Injectable 25%25%None
PEG-INTRON 100MCG KIT   5 Tier 5 Specialty 25%25%P
PEG-INTRON REDIPEN 120MCG   5 Tier 5 Specialty 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PEG-INTRON REDIPEN 150MCG   5 Tier 5 Specialty 25%25%P
PEG-INTRON REDIPEN 50MCG   5 Tier 5 Specialty 25%25%P
PEG-INTRON REDIPEN 80MCG   5 Tier 5 Specialty 25%25%P
PEGANONE 250MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PEGASYS 180MCG/0.5ML CONV.PK   5 Tier 5 Specialty 25%25%P
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM   4 Tier 4 Injectable 25%25%None
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM   4 Tier 4 Injectable 25%25%None
PENICILLIN G POTASSIUM FOR INJECTION   4 Tier 4 Injectable 25%25%None
PENICILLIN G POTASSIUM FOR INJECTION 5000000UNIT/VIAL   4 Tier 4 Injectable 25%25%None
PENICILLIN G PROCAINE 1200000UNT 2ML CTG   4 Tier 4 Injectable 25%25%None
PENICILLIN G SODIUM FOR INJECTION 5000000UNT 1 VIAL   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PENICILLIN V POTASSIUM 250MG TABLET (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PENICILLIN V POTASSIUM 250MG/5ML LIQUID   1 Tier 1 Preferred Generic $4.00$8.00None
PENICILLIN V POTASSIUM 500MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PENICILLIN V POTASSIUM FOR ORAL SOLUTION CONCENTRATE 125MG 200ML BOT   1 Tier 1 Preferred Generic $4.00$8.00None
PENTAM 300 INJ 300MG   4 Tier 4 Injectable 25%25%None
PENTASA 250MG CAPSULE SA   2 Tier 2 Preferred Brand $37.00$74.00None
PENTASA 500MG CAPSULE   2 Tier 2 Preferred Brand $37.00$74.00None
PENTOPAK 400MG TABLET SA   1 Tier 1 Preferred Generic $4.00$8.00None
PENTOSTATIN FOR INJECTION 10MG/VIAL   4 Tier 4 Injectable 25%25%None
PENTOXIFYLLINE 400MG TABLET SA   1 Tier 1 Preferred Generic $4.00$8.00None
PEPCID IV INJECTION 10MG/ML 10X2ML VIALSD   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PEPCID PREMX SOL 20MG/50M   4 Tier 4 Injectable 25%25%None
PEPCID SOLUTION 40MG 24 X 400MG BOT   2 Tier 2 Preferred Brand $37.00$74.00None
PERINDOPRIL ERBUMINE 2 MG ORAL TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PERINDOPRIL ERBUMINE 4 MG ORAL TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:1
/1Days
PERINDOPRIL ERBUMINE 8 MG ORAL TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:2
/1Days
PERIOGARD 0.12% ORAL RINSE   1 Tier 1 Preferred Generic $4.00$8.00None
PERMETHRIN 5% CREAM   1 Tier 1 Preferred Generic $4.00$8.00None
PERPHENAZINE TABLETS 16MG 100 BOT   1 Tier 1 Preferred Generic $4.00$8.00None
PERPHENAZINE TABLETS 4MG 100 BOXUD   1 Tier 1 Preferred Generic $4.00$8.00None
PERPHENAZINE TABLETS 8MG 100 BOT   1 Tier 1 Preferred Generic $4.00$8.00None
PERPHENAZINE TABLETS USP 2MG 100 BOT   1 Tier 1 Preferred Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PFIZERPEN 20MMU VIAL   4 Tier 4 Injectable 25%25%None
PHENADOZ 12.5MG SUPPOSITORY   1 Tier 1 Preferred Generic $4.00$8.00None
PHENADOZ 25MG SUPPOSITORY   1 Tier 1 Preferred Generic $4.00$8.00None
PHENERGAN 25MG/ML VIAL   4 Tier 4 Injectable 25%25%None
PHENERGAN 50MG/ML VIAL   4 Tier 4 Injectable 25%25%None
PHENYTEK 200 MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PHENYTEK 300 MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PHENYTOIN ORAL SUSPENSION 125MG 8 OZ BOT   1 Tier 1 Preferred Generic $4.00$8.00None
PHENYTOIN SOD EXT 200 MG CAP   1 Tier 1 Preferred Generic $4.00$8.00None
PHENYTOIN SODIUM EXTENDED CAPSULES 100MG (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PHENYTOIN SODIUM INJECTION 50MG 25 X 2ML AMP   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PHISOHEX 3% CLEANSER   2 Tier 2 Preferred Brand $37.00$74.00Q:16
/1Days
PHOSPHOLINE IODIDE 0.125%   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PHOTOFRIN 75MG VIAL   4 Tier 4 Injectable 25%25%None
PHYSIOLYTE SOLUTION FOR IRRIGATION   1 Tier 1 Preferred Generic $4.00$8.00None
PHYSIOSOL IRRIGATION SOL   1 Tier 1 Preferred Generic $4.00$8.00None
PILOCARPINE HCL 5MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PILOCARPINE HCL 7.5MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PILOPINE HS 4% EYE GEL   2 Tier 2 Preferred Brand $37.00$74.00None
PIPERACILLIN 200 MG/ML / TAZOBACTAM 25 MG/ML INJECTABLE SOLUTION   4 Tier 4 Injectable 25%25%None
PIPERACILLIN 3GM VIAL   4 Tier 4 Injectable 25%25%None
PIPERACILLIN 40GM BULK VIAL   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PIROXICAM 10 MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00None
PIROXICAM 20MG CAPSULE (500 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PLASMA-LYTE 148 IV SOLUTION   4 Tier 4 Injectable 25%25%P
PLASMA-LYTE 148/DEXTROSE 5%   4 Tier 4 Injectable 25%25%P
PLASMA-LYTE 56 INJECTION 32;128 MG/100ML;   4 Tier 4 Injectable 25%25%P
PLASMA-LYTE 56/DEXTROSE 5%   4 Tier 4 Injectable 25%25%P
PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML;   4 Tier 4 Injectable 25%25%P
PLASMA-LYTE INJ-R   4 Tier 4 Injectable 25%25%P
PLAVIX 75MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PLAVIX TABLETS 300MG   2 Tier 2 Preferred Brand $37.00$74.00None
PLETAL 50MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PODOFILOX 0.5% TOPICAL TUBEX   1 Tier 1 Preferred Generic $4.00$8.00None
POLY-DEX 0.1% SUSPENSION DROPS   1 Tier 1 Preferred Generic $4.00$8.00None
POLY-DEX 3.5-10K-.1 OINTMENT   1 Tier 1 Preferred Generic $4.00$8.00None
POLYCIN-B 500-10KU/G OINTMENT   1 Tier 1 Preferred Generic $4.00$8.00None
POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
POLYETHYLENE GLYCOL 3350 105 MG/ML / POTASSIUM CHLORIDE 0.00497 MEQ/ML / SODIUM BICARBONATE 1.43 MG/   1 Tier 1 Preferred Generic $4.00$8.00None
POLYETHYLENE GLYCOL 3350 105 MG/ML / POTASSIUM CHLORIDE 0.005 MEQ/ML / SODIUM BICARBONATE 0.017 MEQ/   1 Tier 1 Preferred Generic $4.00$8.00None
POLYETHYLENE GLYCOL 3350 59 MG/ML / POTASSIUM CHLORIDE 0.1 MEQ/ML / SODIUM BICARBONATE 0.02 MEQ/ML /   1 Tier 1 Preferred Generic $4.00$8.00None
POLYETHYLENE GLYCOL 3350 60 MG/ML / POTASSIUM CHLORIDE 0.01 MEQ/ML / SODIUM BICARBONATE 0.02 MEQ/ML   1 Tier 1 Preferred Generic $4.00$8.00None
POLYMYXIN B SUL-TRIMETHOPRIM 10K U-0.1%   1 Tier 1 Preferred Generic $4.00$8.00None
POLYMYXIN B SULFATE VIAL   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PORTIA 0.15-0.03 TABLET   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
POTASSIUM CHLORIDE 0.075%/D5W/SODIUM CHLORIDE 0.2%   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.3%   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.45%   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 0.15%/D5W/SODIUM CHLORIDE 0.9% 1000ML   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.2%   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 0.3%/D5W/SODIUM CHLORIDE 0.45% 1000ML BAG   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 10MEQ TABLET SA   1 Tier 1 Preferred Generic $4.00$8.00None
POTASSIUM CHLORIDE 10MEQ/100ML SOL   4 Tier 4 Injectable 25%25%None
POTASSIUM CHLORIDE 10MEQ/50ML SOL   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 20MEQ IN D5W LACT RNG   4 Tier 4 Injectable 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POTASSIUM CHLORIDE 20MEQ IN D5W/NACL 0.225%   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 20MEQ TABLET SR PARTICLES/CRYSTALS   1 Tier 1 Preferred Generic $4.00$8.00None
POTASSIUM CHLORIDE 20MEQ/50ML SOL   4 Tier 4 Injectable 25%25%None
POTASSIUM CHLORIDE 20MEQ/NS 1000ML IV SOLUTION   4 Tier 4 Injectable 25%25%None
POTASSIUM CHLORIDE 30MEQ/100ML SOL   4 Tier 4 Injectable 25%25%None
POTASSIUM CHLORIDE 40MEQ IN D5W LACT RNG   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 40MEQ IN D5W/NACL 0.9%   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE 40MEQ/NS 1000ML IV SOLUTION   4 Tier 4 Injectable 25%25%None
POTASSIUM CHLORIDE 8 MEQ EXTENDED RELEASE TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
POTASSIUM CHLORIDE ER CAPSULES 10MEQ   1 Tier 1 Preferred Generic $4.00$8.00None
POTASSIUM CHLORIDE FOR INJECTION CONCENTRATE   4 Tier 4 Injectable 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
POTASSIUM CHLORIDE IN 10% DEXTROSE AND NACL SOLUTION FOR INJECTION   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN 5% DEXTROSE AND 0.2% NACL SOLUTION FOR INJECTION USP 0.15% 250ML X 24 CASE   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN 5% DEXTROSE AND NACL SOLUTION FOR INJECTION 0.075% 1000ML PLASTIC BAGS X 12 CA   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN 5% DEXTROSE AND SODIUM CHLORIDE INJECTION   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN 5% DEXTROSE INJECTION 40 12 X 1000ML CTR   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN DEXTROSE INJECTION 5GM/75MG   4 Tier 4 Injectable 25%25%P
POTASSIUM CHLORIDE IN SODIUM CHLORIDE INJECTION 0.15%-0.9% 12 X 1000ML BAG   4 Tier 4 Injectable 25%25%None
POTASSIUM CITRATE 10MEQ TABLET SA   1 Tier 1 Preferred Generic $4.00$8.00None
POTASSIUM CITRATE 5MEQ TABLET SA   1 Tier 1 Preferred Generic $4.00$8.00None
PRAMIPEXOLE 0.125 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRAMIPEXOLE 0.25 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PRAMIPEXOLE 0.5 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PRAMIPEXOLE 1 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PRAMIPEXOLE 1.5 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PRANDIN 0.5MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PRANDIN 1MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PRANDIN 2MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PRASUGREL 10 MG ORAL TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
PRASUGREL 5 MG ORAL TABLET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
PRAVASTATIN SODIUM 20MG TABLET 500 BOT   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PRAVASTATIN SODIUM 40MG TABLET (500 CT)   1 Tier 1 Preferred Generic $4.00$8.00Q:2
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRAVASTATIN SODIUM 80MG TABLET (90 CT)   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PRAVASTATIN SODIUM TABLETS 10MG 90 BOT   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PRAZOSIN 5MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00None
PRAZOSIN HCL 1MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00None
PRAZOSIN HCL 2MG CAPSULE   1 Tier 1 Preferred Generic $4.00$8.00None
PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:10
/10Days
PRED MILD 0.12% EYE DROPS   2 Tier 2 Preferred Brand $37.00$74.00None
PREDNICARBATE 0.1% OINTMENT   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PREDNICARBATE 1 MG/ML TOPICAL CREAM   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PREDNISOLONE 5MG/5ML SYRUP   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISOLONE ACETATE OPHTHALMIC SUSPENSION 1.0% STERILE 10ML BOTDR   1 Tier 1 Preferred Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREDNISOLONE SOD 1% EYE DROP   2 Tier 2 Preferred Brand $37.00$74.00None
PREDNISOLONE SODIUM PHOSPHATE 15MG/5ML SOLUTION ORAL   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 10MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 1MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 2.5MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 20MG TABLET (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 5 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 50MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 5MG/5ML SOLUTION   1 Tier 1 Preferred Generic $4.00$8.00None
PREDNISONE 5MG/ML SOLUTION   2 Tier 2 Preferred Brand $37.00$74.00None
PREFEST TABLET 30 EA   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREGNYL INJ 10000UNT   4 Tier 4 Injectable 25%25%P
PREMARIN 0.3MG (100 CT)   2 Tier 2 Preferred Brand $37.00$74.00None
PREMARIN 0.45MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PREMARIN 0.625MG (100 CT)   2 Tier 2 Preferred Brand $37.00$74.00None
PREMARIN 0.9MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PREMARIN 1.25MG (100 CT)   2 Tier 2 Preferred Brand $37.00$74.00None
PREMARIN 25MG VIAL   4 Tier 4 Injectable 25%25%None
PREMARIN VAGINAL CREAM /APPL   2 Tier 2 Preferred Brand $37.00$74.00None
PREMASOL 10% IV SOLUTION   4 Tier 4 Injectable 25%25%P
PREMASOL 6% IV SOLUTION   4 Tier 4 Injectable 25%25%P
PREMPHASE 0.625/5MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PREMPRO 0.3 MG-1.5 MG TABLET #28 EA   2 Tier 2 Preferred Brand $37.00$74.00None
PREMPRO 0.45-1.5 MG TABLET 28 EA   2 Tier 2 Preferred Brand $37.00$74.00None
PRENATABS OBN TABLETS 200;1;150;MG;MG;MCG; 90 BOT   1 Tier 1 Preferred Generic $4.00$8.00None
PREVACID SOLUTAB EXTENDED RELEASE ORALLY DISINTEGRATING 30MG 100 BOXUD   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00S Q:1
/1Days
PREVACID SOLUTAB TABLETS DELAYED RELEASE ORALLY DISINTEGRATING 15MG 100 BOXUD   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00S Q:1
/1Days
PREVALITE POW 4GM   1 Tier 1 Preferred Generic $4.00$8.00None
PREVIFEM TABLETS .035;.25MG;MG 28 BLPK   1 Tier 1 Preferred Generic $4.00$8.00Q:1
/1Days
PREZISTA TABLET 600MG   2 Tier 2 Preferred Brand $37.00$74.00None
PREZISTA TABLET 75MG   2 Tier 2 Preferred Brand $37.00$74.00None
PREZISTA TABLETS 400MG 60 TABLETS BOT   2 Tier 2 Preferred Brand $37.00$74.00None
PRIFTIN 150MG TABLET   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PRIMAQUINE 26.3MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00None
PRIMAXIN I.M. 500MG VIAL   2 Tier 2 Preferred Brand $37.00$74.00None
PRIMAXIN IV 250MG VIAL   2 Tier 2 Preferred Brand $37.00$74.00None
PRIMAXIN IV INJ 500MG   2 Tier 2 Preferred Brand $37.00$74.00None
PRIMIDONE 250MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PRIMIDONE 50MG TABLET (500 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PRIMSOL 50MG/5ML ORAL SOLUTION   2 Tier 2 Preferred Brand $37.00$74.00None
PRISTIQ 100MG TABLET SR 24HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:1
/1Days
PRISTIQ 50MG TABLET SR 24HR   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:1
/1Days
PRIVIGEN 10% VIAL   5 Tier 5 Specialty 25%25%P
PROAIR HFA 90MCG HFA AEROSOL WITH ADAPTER   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROBENECID 500MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROBENECID/COLCHICINE TABLET S   1 Tier 1 Preferred Generic $4.00$8.00None
PROCAINAMIDE 100MG/ML VIAL   4 Tier 4 Injectable 25%25%None
PROCAINAMIDE 500MG/ML VIAL   4 Tier 4 Injectable 25%25%None
PROCALAMINE INJECTION 210MG-290MG-26MG 6 X 1000ML BOT   4 Tier 4 Injectable 25%25%P
PROCHLORPERAZINE EDISYLATE INJECTION 10MG 10 X 2ML VIALS CRTN   4 Tier 4 Injectable 25%25%None
PROCHLORPERAZINE MALEATE 10MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROCHLORPERAZINE MALEATE 5MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX   1 Tier 1 Preferred Generic $4.00$8.00None
PROCRIT 10000U/ML VIAL   2 Tier 2 Preferred Brand $37.00$74.00P
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL   2 Tier 2 Preferred Brand $37.00$74.00P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROCRIT 3000U/ML VIAL   2 Tier 2 Preferred Brand $37.00$74.00P
PROCRIT 40000U/ML VIAL PR   2 Tier 2 Preferred Brand $37.00$74.00P
PROCRIT 4000U/ML VIAL 25 X 1ML VIAL   2 Tier 2 Preferred Brand $37.00$74.00P
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY   2 Tier 2 Preferred Brand $37.00$74.00P
PROCTO-PAK 1% CREAM   1 Tier 1 Preferred Generic $4.00$8.00None
PROCTOCREAM-HC 2.5% CREAM   1 Tier 1 Preferred Generic $4.00$8.00None
PROCTOSOL-HC 2.5% CREAM   1 Tier 1 Preferred Generic $4.00$8.00None
PROCTOZONE-HC 2.5% CREAM   1 Tier 1 Preferred Generic $4.00$8.00None
PROGLYCEM 50MG/ML ORAL SUSP   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PROGRAF 5MG CAPSULE   5 Tier 5 Specialty 25%25%P
PROGRAF 5MG/ML AMPULE   4 Tier 4 Injectable 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROLASTIN 500MG VIAL   2 Tier 2 Preferred Brand $37.00$74.00P
PROLEUKIN 22 MILLION UNITS VL   5 Tier 5 Specialty 25%25%None
PROMACTA TABLETS   5 Tier 5 Specialty 25%25%P
PROMACTA TABLETS 25 MG   5 Tier 5 Specialty 25%25%P
PROMETHAZINE 50MG/ML VIAL   4 Tier 4 Injectable 25%25%None
PROMETHAZINE HCL 12.5MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHAZINE HCL 25MG TABLET (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHAZINE HCL 50MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHAZINE HCL 6.25MG/5ML SYRUP   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHAZINE HCL INJECTION 25MG 10 X 1ML VIAL   4 Tier 4 Injectable 25%25%None
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX   1 Tier 1 Preferred Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHAZINE VC PLAIN 6.25-5MG 16 FL OZ BOT   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHEGAN 25MG SUPP   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETHEGAN 50MG SUPPOS   1 Tier 1 Preferred Generic $4.00$8.00None
PROMETRIUM 100MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PROMETRIUM 200MG CAPSULE   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PROPAFENONE HCL 150MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPAFENONE HCL 225MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROPAFENONE HCL 300MG TABLET (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPARACAINE 0.5% EYE DROPS   1 Tier 1 Preferred Generic $4.00$8.00None
PROPOXY-N/APAP 100-650 TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROPOXY-N/APAP 50-325 TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROPOXYPH-ACETAMINOPHN 100-500   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00None
PROPOXYPHENE HCL AND ACETAMINOPHEN TABLET 650/65MG (500 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPOXYPHENE HCL CAPSULES 65MG (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL 20MG/5ML TUBEX   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL 40MG/5ML TUBEX   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL 60MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL 80 MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL HCL 20MG TABLET (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL HCL CAPSULES ER 120MG (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL HCL CAPSULES ER 160MG (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROPRANOLOL HCL CAPSULES ER 60MG (100 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL HCL CAPSULES ER 80MG (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL HCL INJECTION 1MG 10 PKG OF 10 CRTN   4 Tier 4 Injectable 25%25%None
PROPRANOLOL HCL TABLET USP 10MG (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL HCL TABLET USP 40MG (1000 CT)   1 Tier 1 Preferred Generic $4.00$8.00None
PROPRANOLOL/HCTZ 40/25 TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROPYLTHIOURACIL 50MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PROQUAD VIAL   4 Tier 4 Injectable 25%25%None
PROQUIN XR ER TABLET 582MG   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:3
/14Days
PROSOL 20% INJECTION   4 Tier 4 Injectable 25%25%P
PROTONIX 20MG TABLET EC   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:1
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PROTONIX 40MG SUSP FOR RECON DELAYED REL. IN A PACKET   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
PROTONIX 40MG TABLET EC   3 Tier 3 Non-Preferred Generic Non-Preferred Brand $75.00$188.00Q:1
/1Days
PROTONIX IV 40MG VIAL   4 Tier 4 Injectable 25%25%None
PROTOPIC 0.03% OINTMENT 100GM TUBE   2 Tier 2 Preferred Brand $37.00$74.00P
PROTOPIC 0.1% OINTMENT 60GM TUBE   2 Tier 2 Preferred Brand $37.00$74.00P
PROTRIPTYLINE HYDROCHLORIDE TABLETS   1 Tier 1 Preferred Generic $4.00$8.00None
PROTRIPTYLINE HYDROCHLORIDE TABLETS 5MG   1 Tier 1 Preferred Generic $4.00$8.00None
PROVENTIL HFA INHALER 90MCG AE   2 Tier 2 Preferred Brand $37.00$74.00Q:1
/1Days
PROVIGIL 100MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00P
PROVIGIL 200MG TABLET   2 Tier 2 Preferred Brand $37.00$74.00P
PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION   2 Tier 2 Preferred Brand $37.00$74.00P Q:4
/1Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED   2 Tier 2 Preferred Brand $37.00$74.00None
PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED   2 Tier 2 Preferred Brand $37.00$74.00None
PULMOZYME 1MG/ML AMPUL   5 Tier 5 Specialty 25%25%P Q:3
/1Days
PYRAZINAMIDE 500MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None
PYRIDOSTIGMINE BROMIDE 60MG TABLET   1 Tier 1 Preferred Generic $4.00$8.00None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D Health Net Orange Option 1 (PDP) 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 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 with 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 the drug’s tier. 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 intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $(2840)) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, on the 2011 Humana Walmart-Preferred Rx Plan the pricing 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 2011 )

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.





 
 

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs





Pets are Family Too!
Use your drug discount card to save on medications for the entire family ‐ including your pets.

  • No enrollment fee and no limits on usage
  • Everyone in your household can use the same card, including your pets
Your drug discount card is available to you at no cost.




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.