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Care Improvement Plus

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 a beneficiary would pay for 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 beneficiary 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.

    Transition Policy

    For new members or members transitioning from a hospital or LTC facility, if a beneficiary’s medication is not on the formulary she/he is eligible for a transition supply of a Medicare covered medication until the beneficiary and beneficiary’s doctor can determine if there are formulary alternatives that can be utilized or request an exception from the health plan. Our policy is described in more detail here

    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)

    Beneficiaries may qualify for extra help paying monthly drug plan premium and a portion of 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 a beneficiary’s savings and stocks, but not his/her home or car. If qualified, beneficiaries will get help paying for the Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. Most beneficiaries that receive extra help won’t pay a premium. If a beneficiary qualifies for extra help, she/he won’t have a coverage gap either.

    To see if they qualify for extra help, beneficiaries can 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 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 a beneficiary receives extra help from Medicare to help pay for Medicare prescription drug plan costs, the monthly plan premium will be lower than what it would be if beneficiary did not get extra help from Medicare. The amount of extra help received will determine the total monthly plan premium as a member of our Plan.



    This page was last updated on: 9/26/2011 2:36:16 PM
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    Copyright © 2006 - 2012 Care Improvement Plus
    Y0072_OE12_4511 CMS Approved 11/15/2011

    Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

    The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

    To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

    Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

    You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

    You may be able to get extra help to pay for your prescription drug premiums and costs. 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;
    • 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.

    People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

    Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.