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HealthSpring Prescription Drug Plan -Reg 1 (PDP) (S5932-002-0)
Tier 1 (1909)
Tier 2 (1011)


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2011 Medicare Part D Plan Formulary Information
HealthSpring Prescription Drug Plan -Reg 1 (PDP) (S5932-002-0)
Benefit Details           
The HealthSpring Prescription Drug Plan -Reg 1 (PDP) (S5932-002-0)
Formulary Drugs Starting with the Letter A

in CMS PDP Region 01 which includes: ME NH
Drugs Starting with Letter A

Drug Name
Drug Tier Information Cost-Sharing Drug
Usage
Mgmt
Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
A METHAPRED METHLYPREDNISOLONE SODIUM SUCCINATE FOR INJECTION 125 MG   1 Tier 1 Generic 25%25%None
A-HYDROCORT 100MG VIAL   1 Tier 1 Generic 25%25%None
A-METHAPRED 40MG UNIVIAL   1 Tier 1 Generic 25%25%None
ABELCENT INJECTION SUSPENSION 5MG/ML   2 Tier 2 Brand 25%25%P
ABILIFY 10MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ABILIFY 15MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ABILIFY 1MG/ML SOLUTION   2 Tier 2 Brand 25%25%Q:900
/30Days
ABILIFY 20MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ABILIFY 2MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ABILIFY 30MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ABILIFY 5MG TABLET (OTSUKA)   2 Tier 2 Brand 25%25%Q:30
/30Days
ABILIFY DISCMELT 10MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
ABILIFY DISCMELT 15MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
ABILIFY INJ 9.75MG   2 Tier 2 Brand 25%25%None
ABRAXANE 100MG VIAL   2 Tier 2 Brand 25%25%P
ACARBOSE 100MG TABLET S   1 Tier 1 Generic 25%25%None
ACARBOSE 50MG TABLET S   1 Tier 1 Generic 25%25%None
ACARBOSE TABLETS   1 Tier 1 Generic 25%25%None
ACCOLATE 10MG TABLET   2 Tier 2 Brand 25%25%None
ACCOLATE 20MG TABLET   2 Tier 2 Brand 25%25%None
ACEBUTOLOL 200MG CAPSULE   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACEBUTOLOL 400MG CAPSULE   1 Tier 1 Generic 25%25%None
ACELLULAR PERTUSSIS VACCINE 50 UNT/ML / DIPHTHERIA TOXOID VACCINE 50 UNT/ML / TETANUS TOXOID VACCINE   2 Tier 2 Brand 25%25%None
ACETAMINOPHEN AND CODEINE PHOSPHATE SOLUTION ORAL USP 120;12MG/5ML;MG/ 12.5 ML CUPUD   1 Tier 1 Generic 25%25%Q:5000
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-30MG (60 CT)   1 Tier 1 Generic 25%25%Q:360
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET 300MG-60MG (500 CT)   1 Tier 1 Generic 25%25%Q:240
/30Days
ACETAMINOPHEN AND CODEINE PHOSPHATE TABLET USP 300MG-15MG (100 CT)   1 Tier 1 Generic 25%25%Q:360
/30Days
ACETASOL HC SOLUTION 10ML 10 ML BOT   1 Tier 1 Generic 25%25%None
ACETAZOLAMIDE 125MG TABLET   1 Tier 1 Generic 25%25%None
ACETAZOLAMIDE 250MG TABLET (100 CT)   1 Tier 1 Generic 25%25%None
ACETAZOLAMIDE EXTENDED RELEASE CAPSULES 500MG 100 BOT   1 Tier 1 Generic 25%25%None
ACETAZOLAMIDE SOD 500MG VL   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACETIC ACID 2% SOLUTION NON-ORAL   1 Tier 1 Generic 25%25%None
ACETYLCYSTEINE 10% VIAL   1 Tier 1 Generic 25%25%P
ACETYLCYSTEINE 20% VIAL 3 X 30ML CRTN   1 Tier 1 Generic 25%25%P
ACTHIB VACCINE VIAL 10-24UNT/5ML   2 Tier 2 Brand 25%25%None
ACTICIN 5% CREAM   1 Tier 1 Generic 25%25%None
ACTIMMUNE SOLUTION FOR INJECTION 100MCG   2 Tier 2 Brand 25%25%None
ACTONEL 150MG TABLET   2 Tier 2 Brand 25%25%Q:1
/28Days
ACTONEL 30MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ACTONEL 35MG TABLET   2 Tier 2 Brand 25%25%Q:4
/28Days
ACTONEL 5MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ACTOPLUS MET 15MG/500MG TABLET   2 Tier 2 Brand 25%25%Q:90
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACTOPLUS MET 15MG/850MG TABLET   2 Tier 2 Brand 25%25%Q:90
/30Days
ACTOS 15MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ACTOS 30MG TABLET (500 CT)   2 Tier 2 Brand 25%25%Q:30
/30Days
ACTOS 45MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
ACYCLOVIR 200MG CAPSULE (1000 CT)   1 Tier 1 Generic 25%25%None
ACYCLOVIR 200MG/5ML SUSP   1 Tier 1 Generic 25%25%None
ACYCLOVIR 400MG TABLET (100 CT)   1 Tier 1 Generic 25%25%None
ACYCLOVIR 800 MG ORAL TABLET   1 Tier 1 Generic 25%25%None
ACYCLOVIR SODIUM 500MG VIAL   1 Tier 1 Generic 25%25%P
ADACEL VIAL 2UNT/5UNT   2 Tier 2 Brand 25%25%None
ADAGEN 250U/ML VIAL   2 Tier 2 Brand 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA]   2 Tier 2 Brand 25%25%P
ADVAIR DISKU MIS 100/50   2 Tier 2 Brand 25%25%Q:60
/30Days
ADVAIR DISKU MIS 250/50   2 Tier 2 Brand 25%25%Q:60
/30Days
ADVAIR DISKU MIS 500/50   2 Tier 2 Brand 25%25%Q:60
/30Days
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL   2 Tier 2 Brand 25%25%Q:24
/30Days
ADVAIR HFA INHALER 230;21MCG;MCG   2 Tier 2 Brand 25%25%Q:24
/30Days
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL   2 Tier 2 Brand 25%25%Q:24
/30Days
AFEDITAB CR 30MG TABLET SA   1 Tier 1 Generic 25%25%None
AFEDITAB CR 60MG TABLET SA   1 Tier 1 Generic 25%25%None
AFINITOR TABLETS   2 Tier 2 Brand 25%25%P Q:30
/30Days
AFINITOR TABLETS   2 Tier 2 Brand 25%25%P Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AFINITOR TABLETS 5 MG   2 Tier 2 Brand 25%25%P Q:30
/30Days
AGGRENOX 25-200MG CAPSULE   2 Tier 2 Brand 25%25%None
AK-CON 0.1% EYE DROPS   1 Tier 1 Generic 25%25%None
AKTOB 0.3% EYE DROPS   1 Tier 1 Generic 25%25%None
ALA-CORT 1% CREAM   1 Tier 1 Generic 25%25%None
ALA-CORT 1% LOTION   1 Tier 1 Generic 25%25%None
ALA-SCALP HP 2% LOTION   1 Tier 1 Generic 25%25%None
ALBENZA 200MG TABLET   2 Tier 2 Brand 25%25%None
ALBUTEROL SULFATE 0.63MG/3ML VIAL NEBULIZER   1 Tier 1 Generic 25%25%P Q:375
/30Days
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER   1 Tier 1 Generic 25%25%P Q:375
/30Days
ALBUTEROL SULFATE 4MG TABLET SR 12HR   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALBUTEROL SULFATE 8MG TABLET SR 12HR   1 Tier 1 Generic 25%25%None
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR   1 Tier 1 Generic 25%25%P Q:360
/30Days
ALBUTEROL SULFATE SOLUTION FOR INHALATION   1 Tier 1 Generic 25%25%P Q:375
/30Days
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT   1 Tier 1 Generic 25%25%None
ALBUTEROL SULFATE TABLET 2MG (500 CT)   1 Tier 1 Generic 25%25%None
ALBUTEROL TABLET 4MG (500 CT)   1 Tier 1 Generic 25%25%None
ALCLOMETASONE DIPROPIONATE 0.05% CREAM   1 Tier 1 Generic 25%25%None
ALCLOMETASONE DIPROPIONATE 0.05% OINTMENT   1 Tier 1 Generic 25%25%None
ALDURAZYME 2.9MG/5ML VIAL   2 Tier 2 Brand 25%25%P
ALENDRONATE SODIUM 10MG TABLET   1 Tier 1 Generic 25%25%Q:30
/30Days
ALENDRONATE SODIUM 40MG TABLET   1 Tier 1 Generic 25%25%Q:30
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALENDRONATE SODIUM 5MG TABLET   1 Tier 1 Generic 25%25%Q:30
/30Days
ALENDRONATE SODIUM TABLET 35MG 20 CRTN   1 Tier 1 Generic 25%25%Q:4
/28Days
ALENDRONATE SODIUM TABLETS 70 MG   1 Tier 1 Generic 25%25%Q:4
/28Days
ALIMTA 500MG VIAL   2 Tier 2 Brand 25%25%P
ALINIA 100MG/5ML SUSPENSION   2 Tier 2 Brand 25%25%None
ALINIA 500MG TABLET   2 Tier 2 Brand 25%25%None
ALISKIREN 150 MG / VALSARTAN 160 MG ORAL TABLET [VALTURNA]   2 Tier 2 Brand 25%25%S
ALISKIREN 300 MG / VALSARTAN 320 MG ORAL TABLET [VALTURNA]   2 Tier 2 Brand 25%25%S
ALKERAN FOR INJECTION 50MG/VIAL 1 VIALSU   2 Tier 2 Brand 25%25%P
ALLOPURINOL SODIUM 500MG VIAL   1 Tier 1 Generic 25%25%None
ALLOPURINOL TABLET 300MG (1000 CT)   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALLOPURINOL TABLETS   1 Tier 1 Generic 25%25%None
ALOCRIL 2% EYE DROPS   2 Tier 2 Brand 25%25%None
ALOXI 0.25MG/5ML   2 Tier 2 Brand 25%25%P
ALPHAGAN P 0.1% DROPS   2 Tier 2 Brand 25%25%None
ALPHAGAN P 0.15% EYE DROPS   2 Tier 2 Brand 25%25%None
AMANTADINE 100MG CAPSULE   1 Tier 1 Generic 25%25%None
AMANTADINE 100MG TABLET   1 Tier 1 Generic 25%25%None
AMBISOME 50MG VIAL   2 Tier 2 Brand 25%25%P
AMCINONIDE 0.1% CREAM   1 Tier 1 Generic 25%25%None
AMCINONIDE 0.1% LOTION   1 Tier 1 Generic 25%25%None
AMCINONIDE 0.1% OINTMENT 60GM TUBE   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMIFOSTINE FOR INJECTION 500MG/VIAL   1 Tier 1 Generic 25%25%P
AMIKACIN 250MG/ML VIAL   1 Tier 1 Generic 25%25%None
AMIKACIN 50MG/ML VIAL   1 Tier 1 Generic 25%25%None
AMILORIDE HCL W/HCTZ 5MG-50MG TABLET   1 Tier 1 Generic 25%25%None
AMILORIDE HYDROCHLORIDE TABLETS 5MG 100 BOT   1 Tier 1 Generic 25%25%None
AMINOPHYLLINE 100MG TABLET   1 Tier 1 Generic 25%25%None
AMINOPHYLLINE 200MG TABLET (1000 CT)   1 Tier 1 Generic 25%25%None
AMINOPHYLLINE INJECTION 250MG 10ML X 25 VIALSD   1 Tier 1 Generic 25%25%None
AMINOSYN 10% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN 3.5% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN 5% IV SOLUTION   1 Tier 1 Generic 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN 7% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN 7%-ELECTROLYTE SOL   1 Tier 1 Generic 25%25%P
AMINOSYN 8.5% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN HBC INJECTION SULFITE FREE 7%   1 Tier 1 Generic 25%25%P
AMINOSYN II 10% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN II 15% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN II 3.5% IN D25W IV   1 Tier 1 Generic 25%25%P
AMINOSYN II 3.5% IN D5W IV   1 Tier 1 Generic 25%25%P
AMINOSYN II 3.5% W/ELEC DEX   1 Tier 1 Generic 25%25%P
AMINOSYN II 4.25% IN D10W   1 Tier 1 Generic 25%25%P
AMINOSYN II 4.25% IN D20W   1 Tier 1 Generic 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN II 4.25% W/ELEC DW   1 Tier 1 Generic 25%25%P
AMINOSYN II 4.25%-D25W IV   1 Tier 1 Generic 25%25%P
AMINOSYN II 5% IN D25W IV   1 Tier 1 Generic 25%25%P
AMINOSYN II 7% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN II 8.5% ELECTROLYT   1 Tier 1 Generic 25%25%P
AMINOSYN II 8.5% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN M 3.5% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN PF INJECTION   1 Tier 1 Generic 25%25%P
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%   1 Tier 1 Generic 25%25%P
AMINOSYN-HF 8% IV SOLUTION   1 Tier 1 Generic 25%25%P
AMINOSYN-PF 7% IV SOLUTION   1 Tier 1 Generic 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMIODARONE HCL 400MG TABLET   1 Tier 1 Generic 25%25%None
AMIODARONE HCL INJECTION   1 Tier 1 Generic 25%25%None
AMIODARONE HYDROCHLORIDE TABLETS   1 Tier 1 Generic 25%25%None
AMITIZA 8MCG CAPSULE   2 Tier 2 Brand 25%25%Q:60
/30Days
AMITIZA CAPSULES 24MCG 60 CAP BOT   2 Tier 2 Brand 25%25%Q:60
/30Days
AMITRIP/CDP 25-10 TABLET   1 Tier 1 Generic 25%25%None
AMITRIP/PERPHEN 10-2 TABLET   1 Tier 1 Generic 25%25%None
AMITRIP/PERPHEN 10-4 TABLET   1 Tier 1 Generic 25%25%None
AMITRIP/PERPHEN 25-2 TABLET   1 Tier 1 Generic 25%25%None
AMITRIP/PERPHEN 25-4 TABLET   1 Tier 1 Generic 25%25%None
AMITRIP/PERPHEN 50-4 TABLET   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMITRIPTYLINE HCL 100MG TABLET   1 Tier 1 Generic 25%25%None
AMITRIPTYLINE HCL 10MG TABLET   1 Tier 1 Generic 25%25%None
AMITRIPTYLINE HCL 150 MG TAB   1 Tier 1 Generic 25%25%None
AMITRIPTYLINE HCL 25MG TABLET USP (100 CT)   1 Tier 1 Generic 25%25%None
AMITRIPTYLINE HCL 75MG TABLET USP (100 CT)   1 Tier 1 Generic 25%25%None
AMITRIPTYLINE HCL TABLETS 50MG 100 BOT   1 Tier 1 Generic 25%25%None
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 12.5 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/12   2 Tier 2 Brand 25%25%None
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 10/160/25]   2 Tier 2 Brand 25%25%None
AMLODIPINE 10 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 320 MG ORAL TABLET [EXFORGE HCT 10/320/25]   2 Tier 2 Brand 25%25%None
AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 12.5 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/12.5   2 Tier 2 Brand 25%25%None
AMLODIPINE 5 MG / HYDROCHLOROTHIAZIDE 25 MG / VALSARTAN 160 MG ORAL TABLET [EXFORGE HCT 5/160/25]   2 Tier 2 Brand 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMLODIPINE BESYLATE 10MG TABLET (90 CT)   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE 2.5MG TABLET (90 CT)   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE 5MG TABLET (90 CT)   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE AND BENAZEPRIL HYDROCHLORIDE CAPSULES   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE-BENAZEPRIL 10MG-20MG CAPSULE   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE-BENAZEPRIL 2.5MG-10MG CAPSULE   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE-BENAZEPRIL 5-10MG CAPSULE   1 Tier 1 Generic 25%25%None
AMLODIPINE BESYLATE-BENAZEPRIL 5MG-20MG CAPSULE   1 Tier 1 Generic 25%25%None
AMMONIUM LACTATE 12% CREAM   1 Tier 1 Generic 25%25%None
AMMONIUM LACTATE 12% LOTION   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMNESTEEM 10MG CAPSULE   1 Tier 1 Generic 25%25%None
AMNESTEEM 20MG CAPSULE   1 Tier 1 Generic 25%25%None
AMNESTEEM 40MG CAPSULE   1 Tier 1 Generic 25%25%None
AMOX TR-K CLV 500-125 MG TAB   1 Tier 1 Generic 25%25%None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5/5 SUSPENSION RECONSTITUTED ORAL   1 Tier 1 Generic 25%25%None
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE   1 Tier 1 Generic 25%25%None
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET   1 Tier 1 Generic 25%25%None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE   1 Tier 1 Generic 25%25%None
AMOX TR-POTASSIUM CLAVULANATE 400-57MG/5 SUSPENSION RECONSTITUTED ORAL   1 Tier 1 Generic 25%25%None
AMOXAPINE 100MG TABLET   1 Tier 1 Generic 25%25%None
AMOXAPINE 150MG TABLET   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXAPINE 25MG TABLET   1 Tier 1 Generic 25%25%None
AMOXAPINE 50MG TABLET   1 Tier 1 Generic 25%25%None
AMOXICILLIN 125MG TABLET CHEW   1 Tier 1 Generic 25%25%None
AMOXICILLIN 200MG TABLET CHEW   1 Tier 1 Generic 25%25%None
AMOXICILLIN 250MG CAPSULE   1 Tier 1 Generic 25%25%None
AMOXICILLIN 400MG TABLET CHEW   1 Tier 1 Generic 25%25%None
AMOXICILLIN 50 MG/ML / CLAVULANATE 12.5 MG/ML ORAL SUSPENSION   1 Tier 1 Generic 25%25%None
AMOXICILLIN 500MG CAPSULE   1 Tier 1 Generic 25%25%None
AMOXICILLIN 500MG TABLET (100 CT)   1 Tier 1 Generic 25%25%None
AMOXICILLIN 875MG TABLET   1 Tier 1 Generic 25%25%None
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS 875;125MG;MG 20 BOT   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS EXTENDED RELEASE 1000;62.5MG;MG   1 Tier 1 Generic 25%25%Q:40
/30Days
AMOXICILLIN CLAVULANATE POTASSIUM FOR SUSPENSION 600-42.9MG 125ML BOT   1 Tier 1 Generic 25%25%None
AMOXICILLIN FOR ORAL SUSPENSION 125MG/5ML 100ML BOT   1 Tier 1 Generic 25%25%None
AMOXICILLIN FOR ORAL SUSPENSION 200MG/5ML 100ML BOTGL   1 Tier 1 Generic 25%25%None
AMOXICILLIN FOR ORAL SUSPENSION 250MG/5ML 100ML BOT   1 Tier 1 Generic 25%25%None
AMOXICILLIN FOR ORAL SUSPENSION 400MG/5ML 50ML BOTGL   1 Tier 1 Generic 25%25%None
AMOXICILLIN TABLET USP CHEWABLE 250MG (250 CT)   1 Tier 1 Generic 25%25%None
AMPHETAMINE SALT COMBO 12.5MG TABLET   1 Tier 1 Generic 25%25%None
AMPHETAMINE SALT COMBO 15MG TABLET   1 Tier 1 Generic 25%25%None
AMPHETAMINE SALT COMBO 30MG TABLET   1 Tier 1 Generic 25%25%None
AMPHETAMINE SALT COMBO 7.5MG TABLET   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPHETAMINE SALTS 20MG TABLET   1 Tier 1 Generic 25%25%None
AMPHETAMINE SALTS 5 MG TAB   1 Tier 1 Generic 25%25%None
AMPHOTEC FOR INJECTION 50MG/VIAL   2 Tier 2 Brand 25%25%P
AMPHOTERICIN B FOR INJECTION 50 MG   1 Tier 1 Generic 25%25%P
AMPICILLIN AND SULBACTAM FOR INJECTION 10-5 1 VIAL   1 Tier 1 Generic 25%25%None
AMPICILLIN AND SULBACTAM FOR INJECTION 2-1 10 VIAL   1 Tier 1 Generic 25%25%None
AMPICILLIN CAPSULES 250MG 100 BOT   1 Tier 1 Generic 25%25%None
AMPICILLIN CAPSULES 500MG 100 BOT   1 Tier 1 Generic 25%25%None
AMPICILLIN FOR INJECTION POWDER   1 Tier 1 Generic 25%25%None
AMPICILLIN FOR INJECTION USP 125MG/ML 1 VIAL   1 Tier 1 Generic 25%25%None
AMPICILLIN FOR ORAL SUSPENSION 250MG 100ML BOT   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPICILLIN POWDER FOR INJECTION 1 GM/ML   1 Tier 1 Generic 25%25%None
AMPYRA ER 10 MG TABLET   2 Tier 2 Brand 25%25%P
AMYLASES 109000 UNT / ENDOPEPTIDASES 68000 UNT / LIPASE 20000 UNT ENTERIC COATED CAPSULE [ZENPEP 20]   2 Tier 2 Brand 25%25%None
AMYLASES 27000 UNT / ENDOPEPTIDASES 17000 UNT / LIPASE 5000 UNT ENTERIC COATED CAPSULE [ZENPEP 5]   2 Tier 2 Brand 25%25%None
AMYLASES 55000 UNT / ENDOPEPTIDASES 34000 UNT / LIPASE 10000 UNT ENTERIC COATED CAPSULE [ZENPEP 10]   2 Tier 2 Brand 25%25%None
AMYLASES 82000 UNT / ENDOPEPTIDASES 51000 UNT / LIPASE 15000 UNT ENTERIC COATED CAPSULE [ZENPEP 15]   2 Tier 2 Brand 25%25%None
ANADROL-50 50MG TABLET (100 CT)   2 Tier 2 Brand 25%25%P
ANAGRELIDE HCL 0.5MG CAPSULE   1 Tier 1 Generic 25%25%None
ANAGRELIDE HCL 1MG CAPSULE   1 Tier 1 Generic 25%25%None
ANASTROZOLE TABLETS   1 Tier 1 Generic 25%25%None
ANCOBON 250MG CAPSULE   2 Tier 2 Brand 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ANCOBON 500MG CAPSULE   2 Tier 2 Brand 25%25%None
ANDROGEL 1%(50MG) GEL PACKET   2 Tier 2 Brand 25%25%None
ANTABUSE 250MG TABLET   2 Tier 2 Brand 25%25%None
ANTABUSE 500MG TABLET   2 Tier 2 Brand 25%25%None
ANZEMET 20MG/ML VIAL   2 Tier 2 Brand 25%25%None
APOKYN 30 MG/3 ML CARTRIDGE   2 Tier 2 Brand 25%25%Q:60
/30Days
APRACLONIDINE 5 MG/ML OPHTHALMIC SOLUTION   1 Tier 1 Generic 25%25%None
APRI 0.15-0.03 TABLET   1 Tier 1 Generic 25%25%None
APTIVUS 250MG CAPSULE   2 Tier 2 Brand 25%25%None
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT   2 Tier 2 Brand 25%25%None
ARANELLE 7-9-5 TABLET   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARANESP 100MCG/ML VIAL   2 Tier 2 Brand 25%25%P
ARANESP 200MCG/0.4ML SYRINGE   2 Tier 2 Brand 25%25%P
ARANESP 200MCG/ML VIAL   2 Tier 2 Brand 25%25%P
ARANESP 25MCG/ML VIAL   2 Tier 2 Brand 25%25%P
ARANESP 300MCG/ML VIAL   2 Tier 2 Brand 25%25%P
ARANESP 500MCG/1ML SYRINGE   2 Tier 2 Brand 25%25%P
ARANESP 60MCG/ML VIAL   2 Tier 2 Brand 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 100MCG/0.5ML 1 SYR   2 Tier 2 Brand 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR   2 Tier 2 Brand 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 25MCG/0.42ML SYR   2 Tier 2 Brand 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR   2 Tier 2 Brand 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR   2 Tier 2 Brand 25%25%P
ARANESP PREFILLED SYRINGE SINGLE USE 60MCG/0.3ML 60MCG/ 0.3ML SYR   2 Tier 2 Brand 25%25%P
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD   2 Tier 2 Brand 25%25%P
ARCALYST INJECTION 220MG/VIAL   2 Tier 2 Brand 25%25%P
ARICEPT 10MG TABLET   2 Tier 2 Brand 25%25%None
ARICEPT 5MG TABLET   2 Tier 2 Brand 25%25%None
ARICEPT ODT 10MG TABLET   2 Tier 2 Brand 25%25%None
ARICEPT ODT 5MG TABLET   2 Tier 2 Brand 25%25%None
ARICEPT TABLETS   2 Tier 2 Brand 25%25%None
ARIMIDEX 1MG TABLET   2 Tier 2 Brand 25%25%None
ARIXTRA 10MG SYRINGE   2 Tier 2 Brand 25%25%Q:11
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARIXTRA 2.5MG SYRINGE   2 Tier 2 Brand 25%25%Q:15
/30Days
ARIXTRA 5MG SYRINGE   2 Tier 2 Brand 25%25%Q:6
/30Days
ARIXTRA 7.5MG SYRINGE   2 Tier 2 Brand 25%25%Q:8
/30Days
AROMASIN 25MG TABLET   2 Tier 2 Brand 25%25%None
ARZERRA INJECTION 100MG/5ML   2 Tier 2 Brand 25%25%P
ASACOL 400MG TABLET EC   2 Tier 2 Brand 25%25%None
ASCOMP W/CODEINE 30-50-325 CAPSULE   1 Tier 1 Generic 25%25%Q:360
/30Days
ASENAPINE 10 MG SUBLINGUAL TABLET [SAPHRIS]   2 Tier 2 Brand 25%25%Q:60
/30Days
ASENAPINE 5 MG SUBLINGUAL TABLET [SAPHRIS]   2 Tier 2 Brand 25%25%Q:60
/30Days
ASTRAMORPH PF INJECTION   1 Tier 1 Generic 25%25%None
ASTRAMORPH PF INJECTION 1MG/ML   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATAMET   1 Tier 1 Generic 25%25%None
ATENOLOL 25MG TABLET (100 CT)   1 Tier 1 Generic 25%25%None
ATENOLOL TABLET USP 50MG (100 CT)   1 Tier 1 Generic 25%25%None
ATENOLOL TABLETS USP 100MG 1 BLPK   1 Tier 1 Generic 25%25%None
ATENOLOL/CHLORTHALIDONE TABLET 100-25MG (100 CT)   1 Tier 1 Generic 25%25%None
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)   1 Tier 1 Generic 25%25%None
ATGAM 50MG/ML AMPUL   2 Tier 2 Brand 25%25%P
ATRIPLA TABLET 600MG/200MG   2 Tier 2 Brand 25%25%None
ATROPINE 0.025 MG / DIPHENOXYLATE 2.5 MG ORAL TABLET   1 Tier 1 Generic 25%25%None
ATROPINE 0.05MG/ML SYRINGE   1 Tier 1 Generic 25%25%None
ATROPINE 0.1MG/ML SYRINGE   1 Tier 1 Generic 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATROVENT HFA AER 17MCG   2 Tier 2 Brand 25%25%Q:26
/30Days
ATTENUVAX VACCINE W/DILUENT 1 DOSE/0.5ML   2 Tier 2 Brand 25%25%None
AVALIDE 150-12.5MG TABLET   2 Tier 2 Brand 25%25%None
AVALIDE 300-12.5MG TABLET   2 Tier 2 Brand 25%25%None
AVALIDE 300-25MG TABLET   2 Tier 2 Brand 25%25%None
AVANDAMET 2MG/1000MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDAMET 2MG/500MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDAMET 4MG/500MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDAMET TABLET 4-1000MG   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDARYL 4MG/1MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDARYL 4MG/2MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVANDARYL 4MG/4MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
AVANDARYL 8MG-2MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
AVANDARYL 8MG-4MG TABLET   2 Tier 2 Brand 25%25%Q:30
/30Days
AVANDIA 2MG TABLET   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDIA 4MG TABLET (90 CT)   2 Tier 2 Brand 25%25%Q:60
/30Days
AVANDIA 8MG TABLET (90 CT)   2 Tier 2 Brand 25%25%Q:30
/30Days
AVAPRO 150MG TABLET   2 Tier 2 Brand 25%25%None
AVAPRO 300MG TABLET   2 Tier 2 Brand 25%25%None
AVAPRO 75MG TABLET (30 CT)   2 Tier 2 Brand 25%25%None
AVASTIN 100MG/4ML VIAL   2 Tier 2 Brand 25%25%P
AVELOX 400MG TABLET   2 Tier 2 Brand 25%25%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVELOX ABC PACK 400MG TABLET   2 Tier 2 Brand 25%25%None
AVELOX IV 400MG/250ML   2 Tier 2 Brand 25%25%None
AVIANE 0.1-0.02 TABLET   1 Tier 1 Generic 25%25%None
AVITA 0.025% CREAM   1 Tier 1 Generic 25%25%P Q:45
/30Days
AVODART 0.5MG SOFTGEL   2 Tier 2 Brand 25%25%None
AVONEX ADMIN PACK 30MCG SYR   2 Tier 2 Brand 25%25%P Q:4
/30Days
AVONEX ADMIN PACK 30MCG VL   2 Tier 2 Brand 25%25%P Q:4
/30Days
AZACTAM INJECTION   2 Tier 2 Brand 25%25%None
AZACTAM INJECTION 1GM/50ML   2 Tier 2 Brand 25%25%None
AZACTAM INJECTION 2GM/VIL   2 Tier 2 Brand 25%25%None
AZASAN 100MG TABLET   2 Tier 2 Brand 25%25%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZASAN 75MG TABLET   2 Tier 2 Brand 25%25%P
AZASITE 1% DROPS   2 Tier 2 Brand 25%25%None
AZATHIOPRINE 50MG TABLET   1 Tier 1 Generic 25%25%P
AZELASTINE 137 MCG NASAL SPRAY   1 Tier 1 Generic 25%25%Q:60
/30Days
AZELASTINE HYDROCHLORIDE OPHTHALMIC SOLUTION   1 Tier 1 Generic 25%25%None
AZILECT 0.5MG TABLET   2 Tier 2 Brand 25%25%None
AZILECT 1MG TABLET   2 Tier 2 Brand 25%25%None
AZITHROMYCIN 100MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Tier 1 Generic 25%25%Q:30
/5Days
AZITHROMYCIN 200MG/5ML SUSPENSION RECONSTITUTED ORAL   1 Tier 1 Generic 25%25%Q:68
/5Days
AZITHROMYCIN 250 MG TABLET   1 Tier 1 Generic 25%25%Q:6
/30Days
AZITHROMYCIN 33.3 MG/ML ER SUSPENSION [ZMAX]   2 Tier 2 Brand 25%25%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZITHROMYCIN 500MG TABLET (30 CT)   1 Tier 1 Generic 25%25%Q:3
/30Days
AZITHROMYCIN FOR INJECTION 500MG 10 VIALSD   1 Tier 1 Generic 25%25%None
AZITHROMYCIN TABLETS   1 Tier 1 Generic 25%25%None
AZTREONAM FOR INJECTION   1 Tier 1 Generic 25%25%None

Chart Legend:

Below are a few notes to help you understand the above 2011 Medicare Part D HealthSpring Prescription Drug Plan -Reg 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.







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.