Formulary and Drug Pricing Tool
Medicare Prescription Drug Plans
Formulary
A formulary is a list of drugs selected by Care Improvement Plus in consultation with a team of health care
providers, which represents the prescription therapies believed to be a necessary part of a quality treatment
program. The formulary consists of both generic and brand name drugs.
Care Improvement Plus will generally cover the drugs listed in our formulary as long as the drug is medically
necessary, the prescription is filled at a Care Improvement Plus network pharmacy, and other plan rules are followed.
Click on the link below to view the most current list of drugs covered on Care Improvement Plus’ formulary.
2012 Tier 4 Formulary
Click on the links below to find out more information about the criteria for drugs that require a prior authorization, step therapy, or have a quantity limit.
Prior Authorization Criteria
Step Therapy Criteria
Quantity Limit Medications
Drug Pricing Tool
Each Care Improvement Plus Plan has a drug pricing tool that was specifically designed to show beneficiaries how
much their prescriptions will cost during all coverage stages (initial coverage, coverage gap – doughnut hole,
and catastrophic coverage).
Search for a drug in 5 easy steps:
- Click one of the drug pricing tool links below:
- Select a state from the dropdown list and click Continue.
- Enter drug name and click Search, or use the alphabet list of commonly prescribed medications to find a drug that begins with that letter.
- Select the drug's strength...
- The prices that display reflect the cost of the entered drug in all coverage stages.
Click here to find out how much you would pay for your drug(s).
Care Improvement Plus Silver Rx (Regional PPO SNP) (PPO SNP)
Care Improvement Plus Gold Rx (Regional PPO SNP) (PPO SNP) (HMO SNP)
Care Improvement Plus Dual Advantage (Regional PPO SNP) (PPO SNP)
Care Improvement Plus Medicare Advantage (Regional PPO) (PPO)
Upcoming Changes to Care Improvement Plus' Formulary
Care Improvement Plus may add or remove drugs from the formulary during the year. If we remove drugs from our formulary, add prior authorization(s), quantity limits and/or step therapy restriction(s) on a drug, and/or move a drug to a higher cost-sharing tier, we will notify you of the change at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, in which case we will immediately remove the drug from our formulary and notify you of the change.
Click here
to see the most recent changes to our formulary.
Mail Order
For obtaining prescription drugs by mail, use the following
Mail Order Form, and include a completed
Health, Allergy, and Medication Questionnaire.
Extra Help (Low Income Subsidy)
You may qualify for extra help paying your monthly drug plan premium and a portion of your prescription drug costs – and even prescription drug coverage through the coverage gap.
Extra help is provided by Medicare to pay prescription drug costs for people who meet specific income and resource limits. Resources include your savings and stocks, but not your home or car. If you qualify, you will get help paying for your Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. In most cases, if you get extra help, you won’t pay a premium. If you qualify for extra help, you won’t have a coverage gap either.
To see if you qualify, call: 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213 between 7:00 am and 7:00 pm, Monday through Friday, TTY/TDD users should call 1-800-325-0778; or your State Medicaid Office.
Care Improvement Plus also contracts with Social Services Coordinators (SSC) who can help you find assistance with drug costs if you qualify. You can call SSC at 866-868-2155.
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
Part D Vaccine
If you have been prescribed a vaccine that is covered under Medicare and was administered by your physician, your physician may submit the claim to Medco for reimbursement and collect only your copay by submitting the Vaccine Claim form to:
Medco Health Solutions, Inc.
P.O. Box 14718
Lexington, KY 40512
Upon receipt of the HCFA 1500 from the physician, Medco will process the paper claim and return reimbursement to the physician's office with an explanation of payment including the beneficiary's cost share for collection.
Additional Information:
- You can get additional information from the Centers for Medicare and Medicaid Services by calling 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), which is the national Medicare help line, 24 hours a day, 7 days a week.
- As a Care Improvement Plus member, you may request the aggregate number of Care Improvement Plus grievances, appeals and exceptions, by calling Member Services.
This page was last updated on: 9/2/2010 4:52:21 PM
