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Magellan Rx Medicare Basic (PDP) (S4607-023-0)
Tier 1 (349)
Tier 2 (1516)
Tier 3 (229)
Tier 4 (816)
Tier 5 (748)
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 
2018 Medicare Part D Plan Formulary Information
Magellan Rx Medicare Basic (PDP) (S4607-023-0)
Benefit Details           
The Magellan Rx Medicare Basic (PDP) (S4607-023-0)
Formulary Drugs Starting with the Letter A

in CMS PDP Region 28 which includes: AZ
Plan Monthly Premium: $31.70 Deductible: $405 Qualifies for LIS: Yes
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
ABACAVIR 20 MG/ML SOLUTION   2 Generic $3.00N/ANone
ABACAVIR 300 MG TABLET   4 Non-Preferred Drug 50%N/ANone
Abacavir Sulfate-Lamivudine-Zidovudine tablets [Trizivir]   5 Specialty Tier 25%N/AQ:60
/30Days
ABACAVIR-LAMIVUDINE 600-300 MG   5 Specialty Tier 25%N/AQ:30
/30Days
ABELCET INJECTION SUSPENSION 5MG/ML   5 Specialty Tier 25%N/AP
ABILIFY MAINTENA ER 300 MG SYR   5 Specialty Tier 25%N/ANone
ABILIFY MAINTENA ER 300 MG VL   5 Specialty Tier 25%N/ANone
ABILIFY MAINTENA ER 400 MG SUSER VIAL   5 Specialty Tier 25%N/ANone
ABILIFY MAINTENA ER 400 MG SYR   5 Specialty Tier 25%N/ANone
ABRAXANE 100MG VIAL   5 Specialty Tier 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Acamprosate Calcium DR 333 MG tablets [Campral]   2 Generic $3.00N/ANone
ACARBOSE 100 MG TABLET   2 Generic $3.00N/ANone
ACARBOSE 25 MG TABLET   2 Generic $3.00N/ANone
ACARBOSE 50 MG TABLET   2 Generic $3.00N/ANone
ACEBUTOLOL 200 MG CAPSULE   2 Generic $3.00N/ANone
ACEBUTOLOL 400 MG CAPSULE   2 Generic $3.00N/ANone
ACETAMINOP-CODEINE 120-12 MG/5   1 Preferred Generic $1.00N/AQ:4500
/30Days
Acetaminophen 325 MG / Hydrocodone Bitartrate 5 MG Oral Tablet [Lorcet]   2 Generic $3.00N/AQ:360
/30Days
ACETAMINOPHEN-COD #2 TABLET   2 Generic $3.00N/AQ:390
/30Days
ACETAMINOPHEN-COD #3 TABLET   2 Generic $3.00N/AQ:360
/30Days
ACETAMINOPHEN-COD #4 TABLET   2 Generic $3.00N/AQ:180
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACETAZOLAMIDE 125MG TABLET   2 Generic $3.00N/ANone
ACETAZOLAMIDE 250MG TABLET (100 CT)   2 Generic $3.00N/ANone
Acetazolamide 500mg/5mL 1 VIAL in 1 CARTON / 5 mL in 1 VIAL   5 Specialty Tier 25%N/ANone
ACETAZOLAMIDE ER 500 MG CAP   2 Generic $3.00N/ANone
ACETIC ACID 2% EAR SOLUTION   2 Generic $3.00N/ANone
ACETYLCYSTEINE 10% VIAL   2 Generic $3.00N/AP
Acetylcysteine 200 MG/ML Inhalant Solution   2 Generic $3.00N/AP
ACITRETIN 10 MG CAPSULE [Soriatane]   4 Non-Preferred Drug 50%N/ANone
ACITRETIN 17.5 MG CAPSULE [Soriatane]   5 Specialty Tier 25%N/ANone
ACITRETIN 25 MG CAPSULE [Soriatane]   4 Non-Preferred Drug 50%N/ANone
ACTHIB VACCINE WITH DILUENT   3 Preferred Brand 14%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ACTIMMUNE 100 MCG/0.5 ML VIAL   5 Specialty Tier 25%N/AP
ACYCLOVIR 200 MG CAPSULE   1 Preferred Generic $1.00N/ANone
ACYCLOVIR 200 MG/5 ML SUSP   4 Non-Preferred Drug 50%N/ANone
ACYCLOVIR 400 MG TABLET   2 Generic $3.00N/ANone
ACYCLOVIR 800 MG TABLET   2 Generic $3.00N/ANone
Acyclovir sodium 500 mg vial   4 Non-Preferred Drug 50%N/AP
ADACEL TDAP SYRINGE   3 Preferred Brand 14%N/ANone
ADACEL VIAL 2UNT/5UNT   3 Preferred Brand 14%N/ANone
ADAGEN 250U/ML VIAL   5 Specialty Tier 25%N/AP
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA]   5 Specialty Tier 25%N/AP
ADAPALENE 0.1% CREAM   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADAPALENE 0.1% GEL   2 Generic $3.00N/ANone
Adapalene 0.3% gel   2 Generic $3.00N/ANone
ADCIRCA TABLETS 20MG 60 BOTTLE   5 Specialty Tier 25%N/AP Q:60
/30Days
ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera]   5 Specialty Tier 25%N/ANone
ADEMPAS 0.5 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
ADEMPAS 1 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
ADEMPAS 1.5 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
ADEMPAS 2 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
ADEMPAS 2.5 MG TABLET   5 Specialty Tier 25%N/AP Q:90
/30Days
Adriamycin 20 mg/10 ml vial   2 Generic $3.00N/AP
ADRUCIL 50mg/mL 10 VIAL in 1 TRAY / 10 mL in 1 VIAL   2 Generic $3.00N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ADVAIR DISKUS MIS 100/50   3 Preferred Brand 14%N/AQ:60
/30Days
ADVAIR DISKUS MIS 250/50   3 Preferred Brand 14%N/AQ:60
/30Days
ADVAIR DISKUS MIS 500/50   3 Preferred Brand 14%N/AQ:60
/30Days
ADVAIR HFA 230; 21ug/1; ug/1 120 AEROSOL, METERED in 1 INHALER   3 Preferred Brand 14%N/AQ:24
/30Days
ADVAIR HFA INHALER 115;21MCG;MCG 120ACTN INHL   3 Preferred Brand 14%N/AQ:24
/30Days
ADVAIR HFA INHALER 45;21MCG;MCG 120 ACTN INHL   3 Preferred Brand 14%N/AQ:24
/30Days
AFEDITAB CR 30MG TABLET SA   2 Generic $3.00N/ANone
AFEDITAB CR 60MG TABLET SA   2 Generic $3.00N/ANone
Afinitor 7.5mg/1 28 BLISTER PACK per CARTON / 1 TABLET per BLISTER PACK   5 Specialty Tier 25%N/AP Q:30
/30Days
AFINITOR DISPERZ 2 MG TABLET   5 Specialty Tier 25%N/AP
AFINITOR DISPERZ 3 MG TABLET   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AFINITOR DISPERZ 5 MG TABLET   5 Specialty Tier 25%N/AP
AFINITOR TABLETS 10 MG   5 Specialty Tier 25%N/AP Q:30
/30Days
AFINITOR TABLETS 2.5 MG   5 Specialty Tier 25%N/AP Q:30
/30Days
AFINITOR TABLETS 5 MG   5 Specialty Tier 25%N/AP Q:30
/30Days
Ala-cort 2.5% cream   1 Preferred Generic $1.00N/ANone
ALBENZA 200 MG TABLET   5 Specialty Tier 25%N/ANone
ALBUTEROL SUL 2.5 MG/3 ML SOLN   2 Generic $3.00N/AP Q:525
/30Days
ALBUTEROL SULFATE 0.75mg/3mL 30 POUCH per CARTON / 1 VIAL, SINGLE-DOSE in 1 POUCH / 3 mL in 1 VIAL   2 Generic $3.00N/AP Q:375
/30Days
ALBUTEROL SULFATE 1.25MG/3ML VIAL NEBULIZER   2 Generic $3.00N/AP Q:375
/30Days
ALBUTEROL SULFATE 2 MG TAB   4 Non-Preferred Drug 50%N/ANone
ALBUTEROL SULFATE 4 MG TAB   4 Non-Preferred Drug 50%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALBUTEROL SULFATE INHALATION SOLUTION 0.5% 20ML BOTDR   2 Generic $3.00N/AP Q:100
/30Days
ALBUTEROL SULFATE SYRUP 2MG/5ML 16 FLO BOT   4 Non-Preferred Drug 50%N/ANone
ALCLOMETASONE DIPR 0.05% OINT   2 Generic $3.00N/ANone
ALCLOMETASONE DIPRO 0.05% CRM   2 Generic $3.00N/ANone
ALDURAZYME 2.9MG/5ML VIAL   5 Specialty Tier 25%N/AP
ALECENSA 150 MG CAPSULE   5 Specialty Tier 25%N/AP Q:240
/30Days
ALENDRONATE SODIUM 10 MG TAB   1 Preferred Generic $1.00N/ANone
ALENDRONATE SODIUM 35 MG TAB   1 Preferred Generic $1.00N/ANone
ALENDRONATE SODIUM 40 MG TABLET   1 Preferred Generic $1.00N/ANone
ALENDRONATE SODIUM 5 MG TABLET   1 Preferred Generic $1.00N/ANone
ALENDRONATE SODIUM 70 MG TAB   1 Preferred Generic $1.00N/AQ:4
/28Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALENDRONATE SODIUM 70 MG/75 ML   2 Generic $3.00N/ANone
ALFUZOSIN HCL ER 10 MG TABLET   2 Generic $3.00N/ANone
ALIMTA 100 MG VIAL   5 Specialty Tier 25%N/AP
ALIMTA 500 MG VIAL   5 Specialty Tier 25%N/AP
ALIQOPA 60 MG VIAL   5 Specialty Tier 25%N/AP
ALLOPURINOL 100 MG TABLET   2 Generic $3.00N/ANone
ALLOPURINOL 300 MG TABLET   2 Generic $3.00N/ANone
ALOSETRON HCL 0.5 MG TABLET [Lotronex]   5 Specialty Tier 25%N/AP
ALOSETRON HCL 1 MG TABLET [Lotronex]   5 Specialty Tier 25%N/AP
ALOXI 0.25 MG/5 ML   4 Non-Preferred Drug 50%N/ANone
ALPRAZOLAM 0.25 MG TABLET   1 Preferred Generic $1.00N/AQ:120
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALPRAZOLAM 0.5 MG TABLET   1 Preferred Generic $1.00N/AQ:120
/30Days
ALPRAZOLAM 1 MG TABLET   1 Preferred Generic $1.00N/AQ:120
/30Days
ALPRAZOLAM 2 MG TABLET   1 Preferred Generic $1.00N/AQ:150
/30Days
ALPRAZOLAM ER 0.5 MG TABLET   2 Generic $3.00N/AQ:30
/30Days
ALPRAZOLAM ER 1 MG TABLET   2 Generic $3.00N/AQ:30
/30Days
ALPRAZOLAM ER 2 MG TABLET   2 Generic $3.00N/AQ:150
/30Days
ALPRAZOLAM ER 3 MG TABLET   2 Generic $3.00N/AQ:90
/30Days
ALREX 0.2% EYE DROPS   4 Non-Preferred Drug 50%N/ANone
ALTAVERA-28 TABLET   2 Generic $3.00N/ANone
ALUNBRIG 180 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
ALUNBRIG 30 MG TABLET   5 Specialty Tier 25%N/AP Q:180
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ALUNBRIG 90 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
ALUNBRIG 90 MG-180 MG TABLET PACK   5 Specialty Tier 25%N/AP Q:30
/365Days
ALYACEN 1-35-28 TABLET   2 Generic $3.00N/ANone
AMANTADINE 100 MG CAPSULE   2 Generic $3.00N/ANone
AMANTADINE 100 MG TABLET   2 Generic $3.00N/ANone
AMANTADINE 50 MG/5 ML SOLUTION   2 Generic $3.00N/ANone
AMBISOME 50MG VIAL   5 Specialty Tier 25%N/AP
AMCINONIDE 0.1% CREAM   4 Non-Preferred Drug 50%N/ANone
AMCINONIDE 0.1% LOTION   4 Non-Preferred Drug 50%N/ANone
AMCINONIDE 0.1% OINTMENT 60GM TUBE   4 Non-Preferred Drug 50%N/ANone
AMETHIA 0.15-0.03-0.01 MG TABLET   2 Generic $3.00N/AQ:91
/91Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMETHIA LO TABLET   2 Generic $3.00N/AQ:91
/91Days
AMIKACIN SULF 500 MG/2 ML VIAL   2 Generic $3.00N/ANone
AMILORIDE HCL 5 MG TABLET   2 Generic $3.00N/ANone
AMILORIDE HCL-HCTZ 5-50 MG TABLET   2 Generic $3.00N/ANone
Aminophylline 25 MG/ML 10 ML Injection   2 Generic $3.00N/ANone
AMINOSYN 7%-ELECTROLYTE SOL   4 Non-Preferred Drug 50%N/AP
AMINOSYN HBC INJECTION SULFITE FREE 7%   4 Non-Preferred Drug 50%N/AP
AMINOSYN II 10% SOL 6X2000 ML   4 Non-Preferred Drug 50%N/AP
AMINOSYN II 8.5% ELECTROLYT   2 Generic $3.00N/AP
AMINOSYN PF INJECTION   4 Non-Preferred Drug 50%N/AP
AMINOSYN WITH ELECTROLYTES SULFITE FREE INJECTION 8.5%   2 Generic $3.00N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMINOSYN-PF 7% IV SOLUTION   4 Non-Preferred Drug 50%N/AP
AMINOSYN-RF 5.2% IV SOLUTION   4 Non-Preferred Drug 50%N/AP
AMIODARONE HCL 100 MG TABLET   2 Generic $3.00N/ANone
AMIODARONE HCL 200 MG TABLET   1 Preferred Generic $1.00N/ANone
AMIODARONE HCL 400 MG TABLET   2 Generic $3.00N/ANone
AMIODARONE HCL 50 MG/ML in 3 ML Injection   2 Generic $3.00N/ANone
AMITIZA 8MCG CAPSULE   3 Preferred Brand 14%N/AQ:60
/30Days
AMITIZA CAPSULES 24MCG 60 CAP BOT   3 Preferred Brand 14%N/AQ:60
/30Days
AMITRIP/CDP 25-10 TABLET   4 Non-Preferred Drug 50%N/ANone
AMITRIP/PERPHEN 10-4 TABLET   4 Non-Preferred Drug 50%N/ANone
AMITRIP/PERPHEN 50-4 TABLET   4 Non-Preferred Drug 50%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMITRIPTYLINE HCL 10 MG TAB   4 Non-Preferred Drug 50%N/ANone
AMITRIPTYLINE HCL 100 MG TAB   4 Non-Preferred Drug 50%N/ANone
AMITRIPTYLINE HCL 150 MG TAB   4 Non-Preferred Drug 50%N/ANone
AMITRIPTYLINE HCL 25 MG TAB   4 Non-Preferred Drug 50%N/ANone
AMITRIPTYLINE HCL 50 MG TAB   4 Non-Preferred Drug 50%N/ANone
AMITRIPTYLINE HCL 75 MG TAB   4 Non-Preferred Drug 50%N/ANone
AMLODIPINE BESYLATE 10 MG TAB   1 Preferred Generic $1.00N/ANone
AMLODIPINE BESYLATE 2.5 MG TAB   1 Preferred Generic $1.00N/ANone
AMLODIPINE BESYLATE 5 MG TAB   1 Preferred Generic $1.00N/ANone
AMLODIPINE-ATORVAST 10-20 MG [Caduet]   2 Generic $3.00N/ANone
AMLODIPINE-ATORVAST 10-40 MG [Caduet]   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Amlodipine-Atorvastatin 10-10 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 10-80 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 2.5-10 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 2.5-20 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 2.5-40 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 5-10 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 5-20 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 5-40 mg [Caduet]   2 Generic $3.00N/ANone
Amlodipine-Atorvastatin 5-80 mg [Caduet]   2 Generic $3.00N/ANone
AMLODIPINE-BENAZEPRIL 10-20 MG Capsule [Lotrel]   1 Preferred Generic $1.00N/ANone
AMLODIPINE-BENAZEPRIL 10-40 MG Capsule [Lotrel]   1 Preferred Generic $1.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMLODIPINE-BENAZEPRIL 2.5-10 Capsule [Lotrel]   1 Preferred Generic $1.00N/ANone
AMLODIPINE-BENAZEPRIL 5-10 MG Capsule [Lotrel]   1 Preferred Generic $1.00N/ANone
AMLODIPINE-BENAZEPRIL 5-20 MG Capsule [Lotrel]   1 Preferred Generic $1.00N/ANone
AMLODIPINE-BENAZEPRIL 5-40 MG Capsule [Lotrel]   1 Preferred Generic $1.00N/ANone
AMLODIPINE-VALSARTAN 10-160 MG   1 Preferred Generic $1.00N/ANone
AMLODIPINE-VALSARTAN 10-320 MG   1 Preferred Generic $1.00N/ANone
AMLODIPINE-VALSARTAN 5-160 MG   1 Preferred Generic $1.00N/ANone
AMLODIPINE-VALSARTAN 5-320 MG   1 Preferred Generic $1.00N/ANone
AMMONIUM LACTATE 12% CREAM   2 Generic $3.00N/ANone
AMMONIUM LACTATE 12% LOTION   2 Generic $3.00N/ANone
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin]   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin]   2 Generic $3.00N/ANone
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin]   2 Generic $3.00N/ANone
AMOX-CLAV 200-28.5 MG/5 ML SUS   2 Generic $3.00N/ANone
AMOX-CLAV 250-62.5 MG/5 ML SUS   2 Generic $3.00N/ANone
AMOX-CLAV 400-57 MG/5 ML SUSP   2 Generic $3.00N/ANone
AMOX-CLAV 500-125 MG TABLET [Augmentin]   2 Generic $3.00N/ANone
AMOX-CLAV 600-42.9 MG/5 ML SUS   2 Generic $3.00N/ANone
AMOX-CLAV 875-125 MG TABLET [Augmentin]   2 Generic $3.00N/ANone
AMOX-CLAV ER 1,000-62.5 MG TABLET [Augmentin]   2 Generic $3.00N/ANone
AMOXAPINE 100MG TABLET   2 Generic $3.00N/ANone
AMOXAPINE 150MG TABLET   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXAPINE 25MG TABLET   2 Generic $3.00N/ANone
AMOXAPINE 50MG TABLET   2 Generic $3.00N/ANone
AMOXICILLIN 125 MG/5 ML SUSP   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 125MG TABLET CHEW   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 200 MG/5 ML SUSP   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 250 MG CAPSULE   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 250 MG TAB CHEW   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 250 MG/5 ML SUSP   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 400 MG/5 ML SUSP   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 500 MG CAPSULE   1 Preferred Generic $1.00N/ANone
AMOXICILLIN 500 MG TABLET   1 Preferred Generic $1.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMOXICILLIN 875 MG TABLET   1 Preferred Generic $1.00N/ANone
AMPHETAMINE SALT COMBO 12.5MG TABLET   2 Generic $3.00N/AQ:90
/30Days
AMPHETAMINE SALT COMBO 15MG TABLET   2 Generic $3.00N/AQ:90
/30Days
AMPHETAMINE SALT COMBO 7.5MG TABLET   2 Generic $3.00N/AQ:90
/30Days
AMPHETAMINE SALTS 5 MG TAB   2 Generic $3.00N/AQ:90
/30Days
amphotericin b 50mg/10mL 10 mL in 1 VIAL   4 Non-Preferred Drug 50%N/AP
AMPICILLIN 10 GM VIAL   2 Generic $3.00N/ANone
Ampicillin 1000 MG / Sulbactam 500 MG Injection   2 Generic $3.00N/ANone
Ampicillin 1000 MG Injection   2 Generic $3.00N/ANone
Ampicillin 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS   4 Non-Preferred Drug 50%N/ANone
Ampicillin 2000 MG / Sulbactam 1000 MG Injection   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AMPICILLIN CAPSULES 500MG 100 BOT   1 Preferred Generic $1.00N/ANone
AMPICILLIN-SULBACTAM 15 GM VL   2 Generic $3.00N/ANone
AMPYRA ER 10 MG TABLET   5 Specialty Tier 25%N/AP Q:60
/30Days
ANADROL-50 TABLET   5 Specialty Tier 25%N/AP
Anagrelide Hydrochloride 0.5mg/1 100 CAPSULE BOTTLE   2 Generic $3.00N/ANone
Anagrelide Hydrochloride 1mg/1 100 CAPSULE BOTTLE   2 Generic $3.00N/ANone
ANASTROZOLE 1 MG TABLET   1 Preferred Generic $1.00N/ANone
ANDRODERM 2 MG/24HR PATCH   3 Preferred Brand 14%N/AP
ANDRODERM 4 MG/24HR PATCH   3 Preferred Brand 14%N/AP
ANDROGEL 1.62% (1.25G) GEL PCKT   3 Preferred Brand 14%N/AP
ANDROGEL 1.62% (2.5G) GEL PCKT   3 Preferred Brand 14%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Androgel 16.2mg/g 1 BOTTLE, PUMP per CARTON / 88 g in 1 BOTTLE, PUMP   3 Preferred Brand 14%N/AP
ANORO ELLIPTA 62.5-25 MCG INH   3 Preferred Brand 14%N/AQ:60
/30Days
Antineoplastic Agent Etoposide 20 mg / mL Intravenous Injection Multiple Dose Vial 5 mL   2 Generic $3.00N/ANone
APOKYN 30 MG/3 ML CARTRIDGE   5 Specialty Tier 25%N/AP Q:60
/30Days
Apraclonidine 5 MG/ML Ophthalmic Solution   2 Generic $3.00N/ANone
APREPITANT 125 MG CAPSULE [Emend]   2 Generic $3.00N/AP Q:2
/30Days
APREPITANT 125-80-80 MG PACK [Emend]   2 Generic $3.00N/AP Q:6
/30Days
APREPITANT 40 MG CAPSULE [Emend]   2 Generic $3.00N/AP Q:1
/30Days
APREPITANT 80 MG CAPSULE [Emend]   2 Generic $3.00N/AP Q:8
/30Days
APRI 0.15-0.03 TABLET   2 Generic $3.00N/ANone
APRISO CP24   3 Preferred Brand 14%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
APTIOM 200 MG TABLET   5 Specialty Tier 25%N/ANone
APTIOM 400 MG TABLET   5 Specialty Tier 25%N/ANone
APTIOM 600 MG TABLET   5 Specialty Tier 25%N/ANone
APTIOM 800 MG TABLET   5 Specialty Tier 25%N/ANone
APTIVUS 250MG CAPSULE   5 Specialty Tier 25%N/ANone
APTIVUS ORAL SOLUTION 100MG/ML 95 ML BOT   5 Specialty Tier 25%N/ANone
ARALAST NP 1,000 MG VIAL   5 Specialty Tier 25%N/AP
ARANELLE 7-9-5 TABLET   2 Generic $3.00N/ANone
ARANESP 10 MCG/0.4 ML SYRINGE   4 Non-Preferred Drug 50%N/AP
ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE   5 Specialty Tier 25%N/AP
ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE   5 Specialty Tier 25%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARANESP 200MCG/0.4ML SYRINGE   5 Specialty Tier 25%N/AP
ARANESP 200MCG/ML VIAL   5 Specialty Tier 25%N/AP
ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING   4 Non-Preferred Drug 50%N/AP
ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE   4 Non-Preferred Drug 50%N/AP
ARANESP 300MCG/ML VIAL   5 Specialty Tier 25%N/AP
ARANESP 500MCG/1ML SYRINGE   5 Specialty Tier 25%N/AP
ARANESP 60MCG/ML VIAL   5 Specialty Tier 25%N/AP
ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE   4 Non-Preferred Drug 50%N/AP
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR   5 Specialty Tier 25%N/AP
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR   5 Specialty Tier 25%N/AP
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR   4 Non-Preferred Drug 50%N/AP
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD   4 Non-Preferred Drug 50%N/AP
ARCALYST INJECTION 220MG/VIAL   5 Specialty Tier 25%N/AP
ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify]   4 Non-Preferred Drug 50%N/AQ:750
/30Days
ARIPIPRAZOLE 10 MG TABLET [Abilify]   4 Non-Preferred Drug 50%N/AQ:30
/30Days
ARIPIPRAZOLE 15 MG TABLET [Abilify]   4 Non-Preferred Drug 50%N/AQ:30
/30Days
ARIPIPRAZOLE 2 MG TABLET [Abilify]   4 Non-Preferred Drug 50%N/AQ:60
/30Days
ARIPIPRAZOLE 20 MG TABLET [Abilify]   4 Non-Preferred Drug 50%N/AQ:30
/30Days
ARIPIPRAZOLE 30 MG TABLET [Abilify]   4 Non-Preferred Drug 50%N/AQ:30
/30Days
ARIPIPRAZOLE 5 MG TABLET [Abilify]   4 Non-Preferred Drug 50%N/AQ:60
/30Days
ARIPIPRAZOLE ODT 10 MG TABLET [Abilify]   5 Specialty Tier 25%N/AQ:60
/30Days
ARIPIPRAZOLE ODT 15 MG TABLET [Abilify]   5 Specialty Tier 25%N/AQ:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ARISTADA ER 1064 MG/3.9 ML SYR   5 Specialty Tier 25%N/ANone
ARISTADA ER 441 MG/1.6 ML SYRN   5 Specialty Tier 25%N/ANone
ARISTADA ER 662 MG/2.4 ML SYRN   5 Specialty Tier 25%N/ANone
ARISTADA ER 882 MG/3.2 ML SYRN   5 Specialty Tier 25%N/ANone
ARRANON 250 MG VIAL   5 Specialty Tier 25%N/ANone
ASHLYNA 0.15-0.03-0.01 MG TAB   2 Generic $3.00N/AQ:91
/91Days
ASMANEX HFA 100 MCG INHALER   4 Non-Preferred Drug 50%N/AQ:26
/30Days
ASMANEX HFA 200 MCG INHALER   4 Non-Preferred Drug 50%N/AQ:26
/30Days
ASMANEX TWISTHALER 110 MCG #30   4 Non-Preferred Drug 50%N/AQ:1
/30Days
ASMANEX TWISTHALER 220 MCG #30   4 Non-Preferred Drug 50%N/AQ:1
/30Days
ASMANEX TWISTHALER 220MCG #120   4 Non-Preferred Drug 50%N/AQ:1
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ASMANEX TWISTHALER 220MCG #60   4 Non-Preferred Drug 50%N/AQ:1
/30Days
Aspirin-Diphenhydramine ER 25-200 MG   4 Non-Preferred Drug 50%N/ANone
ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE   4 Non-Preferred Drug 50%N/AQ:390
/30Days
ATAZANAVIR SULFATE 150 MG CAP [Reyataz]   5 Specialty Tier 25%N/ANone
ATAZANAVIR SULFATE 200 MG CAP [Reyataz]   5 Specialty Tier 25%N/ANone
ATAZANAVIR SULFATE 300 MG CAP [Reyataz]   5 Specialty Tier 25%N/ANone
ATENOLOL 100 MG TABLET   1 Preferred Generic $1.00N/ANone
ATENOLOL 25 MG TABLET   1 Preferred Generic $1.00N/ANone
ATENOLOL 50 MG TABLET   1 Preferred Generic $1.00N/ANone
ATENOLOL-CHLORTHALIDONE 100-25   2 Generic $3.00N/ANone
ATENOLOL/CHLORTHALIDONE TABLET 50-25MG (100 CT)   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATGAM 50MG/ML AMPUL   5 Specialty Tier 25%N/AP
ATOMOXETINE HCL 10 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:60
/30Days
ATOMOXETINE HCL 100 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:30
/30Days
ATOMOXETINE HCL 18 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:30
/30Days
ATOMOXETINE HCL 25 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:30
/30Days
ATOMOXETINE HCL 40 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:30
/30Days
ATOMOXETINE HCL 60 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:30
/30Days
ATOMOXETINE HCL 80 MG CAPSULE [Strattera]   2 Generic $3.00N/AQ:30
/30Days
ATORVASTATIN 10 MG TABLET [Lipitor]   1 Preferred Generic $1.00N/ANone
ATORVASTATIN 20 MG TABLET [Lipitor]   1 Preferred Generic $1.00N/ANone
ATORVASTATIN 40 MG TABLET [Lipitor]   1 Preferred Generic $1.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
ATORVASTATIN 80 MG TABLET [Lipitor]   1 Preferred Generic $1.00N/ANone
ATOVAQUONE 750 MG/5 ML SUSP [Mepron]   5 Specialty Tier 25%N/ANone
Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone]   2 Generic $3.00N/ANone
ATOVAQUONE-PROGUANIL 62.5-25 [Malarone]   2 Generic $3.00N/ANone
Atripla 600; 200; 300mg/1; mg/1; mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC   5 Specialty Tier 25%N/AQ:30
/30Days
ATROPINE 1% EYE DROPS   2 Generic $3.00N/ANone
ATROVENT HFA AER 17MCG   4 Non-Preferred Drug 50%N/AQ:26
/30Days
AUBAGIO 14 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
AUBAGIO 7 MG TABLET   5 Specialty Tier 25%N/AP Q:30
/30Days
AUBRA-28 TABLET   2 Generic $3.00N/ANone
AUGMENTIN 125-31.25 MG/5 ML   5 Specialty Tier 25%N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AVASTIN 100MG/4ML VIAL   5 Specialty Tier 25%N/AP
AVASTIN 400 MG/16 ML VIAL   5 Specialty Tier 25%N/AP
AVIANE 0.1-0.02 TABLET   2 Generic $3.00N/ANone
AVONEX ADMIN PACK 30 MCG VL   5 Specialty Tier 25%N/AP Q:4
/28Days
AVONEX PEN 30 MCG/0.5 ML KIT   5 Specialty Tier 25%N/AP Q:4
/28Days
AVONEX PREFILLED SYR 30 MCG KT   5 Specialty Tier 25%N/AP Q:4
/28Days
Azacitidine 100 mg vial [Vidaza]   5 Specialty Tier 25%N/ANone
AZASITE 1% EYE DROPS   4 Non-Preferred Drug 50%N/ANone
AZATHIOPRINE 50 MG TABLET   2 Generic $3.00N/AP
AZATHIOPRINE SODIUM 100 MG VIAL   2 Generic $3.00N/AP
AZELASTINE 0.15% NASAL SPRAY   2 Generic $3.00N/AQ:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZELASTINE 137 MCG NASAL SPRAY   2 Generic $3.00N/AQ:60
/30Days
AZELASTINE HCL 0.05% DROPS   2 Generic $3.00N/ANone
AZITHROMYCIN 1 GM PWD PACKET   2 Generic $3.00N/ANone
AZITHROMYCIN 100 MG/5 ML SUSP   2 Generic $3.00N/ANone
AZITHROMYCIN 200 MG/5 ML SUSP   2 Generic $3.00N/ANone
AZITHROMYCIN 250 MG TABLET   2 Generic $3.00N/ANone
AZITHROMYCIN 250 MG TABLET   2 Generic $3.00N/ANone
AZITHROMYCIN 500 MG TABLET   2 Generic $3.00N/ANone
Azithromycin 500mg/1 30 FILM COATED TABLETS in BOTTLE   2 Generic $3.00N/ANone
AZITHROMYCIN 600 MG TABLET   2 Generic $3.00N/ANone
AZITHROMYCIN I.V. 500 MG VIAL   2 Generic $3.00N/ANone
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
AZOPT 1% EYE DROPS   4 Non-Preferred Drug 50%N/ANone
Aztreonam 1000 MG Injection [Azactam]   4 Non-Preferred Drug 50%N/ANone
Aztreonam 2000 MG Injection [Azactam]   4 Non-Preferred Drug 50%N/ANone
AZTREONAM FOR INJECTION   4 Non-Preferred Drug 50%N/ANone

Chart Legend:

Below are a few notes to help you understand the above 2018 Medicare Part D Magellan Rx Medicare Basic (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). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)

  • 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 $405 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 five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs. *Some Part D plans exclude one or more drug tiers from the deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
    • Tier 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 $3750) at a "Preferred" network pharmacy. In most cases, the "Preferred" network network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    • 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 September 2018 )

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.