ConnectiCare Flex Plan 1 (HMO-POS) Formulary



Below is the 2023 Formulary, or prescription drug list, from ConnectiCare Flex Plan 1 (HMO-POS) by Connecticare, Inc. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Connecticut Medicare Part-C plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you. You’ll want to make sure the medicines you are currently taking are covered under any plans you are considering enrolling in.

This ConnectiCare Flex Plan 1 (HMO-POS)(H3528-006) plan has a $300 drug deductible. A deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. However, some drugs do not require that the deductible is met before you receive coverage. You can see if the deductible is required below in the "Does the Deductible Apply" column. The Initial Coverage Limit (ICL) for this plan is $4660. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 25% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" by clicking the "Coverage Gap" link above the chart.

In 2023 if you have spent $7400 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Connecticare, Inc will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link above the chart.



Plan Overview

Plan Name:ConnectiCare Flex Plan 1
Plan ID: H3528-006
Provider: Connecticare, Inc
Plan Year:2023
Premium:$100.90
Deductible:$300
Initial Coverage Limit:$4660
Coverage Area:Connecticut
Similar Plan:H3528-010


Change Table Options:

Drugs Starting Letter:
Coverage Phase:

*Tip Click the Drug name to Compare Coverage and Retail Cost for Every Plan In Your Area
⇅ Click the Header to Sort
Drug
Name⇅
Tier
Level
Deductible
Apply
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Cabergoline
3Y$42$47$42NN
Cablivi
527%27%27%YN
Cabometyx
527%27%27%30/30YN
Calcipotriene
4Y$95$100$95120/30NN
Calcitriol
4Y$95$100$95NN
Calcium Acetate
3Y$42$47$42360/30NN
Calquence
527%27%27%60/30YN
Camila
2N$10$20$0NN
Candesartan
2N$10$20$0NN
Candesartan Cilexetil And Hydrochlorothiazide
2N$10$20$0NN
Caplyta
4Y$95$100$9530/30NN
Caprelsa
527%27%27%30/30YN
Captopril
2N$10$20$0NN
Carbamazepine
3Y$42$47$42NN
Carbidopa
2N$10$20$0NN
Carbidopa And Levodopa
2N$10$20$0NN
Carbidopa, Levodopa, And Entacapone
4Y$95$100$95NN
Carglumic Acid
527%27%27%YN
Carteolol Hydrochloride
2N$10$20$0NN
Cartia
2N$10$20$0NN
Caspofungin Acetate
4Y$95$100$95NN
Cayston
527%27%27%84/56YN
Caziant
2N$10$20$0NN
Cefaclor
2N$10$20$0NN
Cefadroxil
2N$10$20$0NN
Cefazolin
4Y$95$100$95NN
Cefdinir
2N$10$20$0NN
Cefixime
4Y$95$100$95NN
Cefoxitin
4Y$95$100$95YN
Cefpodoxime Proxetil
4Y$95$100$95NN
Cefprozil
2N$10$20$0NN
Ceftazidime
4Y$95$100$95YN
Ceftriaxone Sodium
4Y$95$100$95NN
Cefuroxime
4Y$95$100$95YN
Celecoxib
2N$10$20$0NN
Celontin
4Y$95$100$95NN
Cephalexin
2N$10$20$0NN
Cevimeline
4Y$95$100$95NN
Chemet
3Y$42$47$42YN
Chenodal
527%27%27%YN
Chlorpromazine Hydrochloride
4Y$95$100$95NN
Chlorthalidone
2N$10$20$0NN
Cholbam
527%27%27%YN
Cholestyramine
3Y$42$47$42NN
Ciclopirox
3Y$42$47$42120/28NN
Ciclopirox Olamine
3Y$42$47$4260/28NN
Cilostazol
2N$10$20$0NN
Cimduo
527%27%27%NN
Cimetidine
2N$10$20$0NN
Cimetidine Hydrochloride
2N$10$20$0NN
Cimzia
527%27%27%2/28YN
Cinacalcet Hydrochloride
4Y$95$100$95YN
Cinryze
527%27%27%YN
Ciprofloxacin
2N$10$20$0NN
Ciprofloxacin And Dexamethasone
3Y$42$47$42NN
Ciprofloxacin Otic
4Y$95$100$95NN
Citalopram Hydrobromide
3Y$42$47$42NN
Claravis
4Y$95$100$95NN
Clarithromycin
2N$10$20$0NN
Clindamycin
4Y$95$100$95YN
Clindamycin Hydrochloride
2N$10$20$0NN
Clindamycin In 5 Percent Dextrose
4Y$95$100$95YN
Clindamycin Palmitate Hydrochloride (pediatric)
4Y$95$100$95NN
Clindamycin Phosphate
3Y$42$47$42NN
Clinimix
4Y$95$100$95YN
Clobazam
4Y$95$100$95480/30YN
Clobetasol Propionate
4Y$95$100$95118/28NN
Clodan
4Y$95$100$95236/28NN
Clomipramine Hydrochloride
4Y$95$100$95NN
Clonazepam
2N$10$20$0300/30NN
Clonidine Hydrochloride
1N$2$9$0NN
Clonidine Transdermal System
4Y$95$100$954/28NN
Clorazepate Dipotassium
3Y$42$47$42180/30YN
Clotrimazole
2N$10$20$0NN
Clotrimazole And Betamethasone Dipropionate
4Y$95$100$9560/28NN
Clotrimazole Topical Solution Usp, 1%
2N$10$20$030/28NN
Clozapine
3Y$42$47$42NN
Coartem
4Y$95$100$95NN
Colchicine
2N$10$20$0NN
Colesevelam Hydrochloride
4Y$95$100$95NN
Colestipol Hydrochloride
4Y$95$100$95NN
Collagenase Santyl
3Y$42$47$42180/30NN
Combivent Respimat
3Y$42$47$428/30NN
Complera
4Y$95$100$95NN
Compro
4Y$95$100$95NN
Corlanor
3Y$42$47$42450/30NN
Cotellic
527%27%27%63/28YN
Creon
3Y$42$47$42NN
Cresemba
4Y$95$100$95YN
Cromolyn Sodium
2N$10$20$0NN
Crotan
2N$10$20$0NN
Cryselle
2N$10$20$0NN
Cyclobenzaprine Hydrochloride
4Y$95$100$95YN
Cyclophosphamide
3Y$42$47$42YN
Cyclosporine
3Y$42$47$42YN
Cyred Eq
2N$10$20$0NN
Cystagon
4Y$95$100$95YN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H3528-006

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $300. Some plans offer select Pre-deductible drug Coverage
2. Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $4660
3. Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7400 in 2023.
4. Catastrophic: Anything over $7400 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2023 is $505. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Cost Preferred: Your Cost for the Drug at the Providers In-Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non-Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plan's formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on

Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

      Site Search:

MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.