PHP Advantage (HMO-POS) Formulary



Below is the 2023 Formulary, or prescription drug list, from PHP Advantage (HMO-POS) by Php Medicare. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Michigan 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 PHP Advantage (HMO-POS)(H7646-003) plan has a $0 drug deductible. 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. Php Medicare 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:PHP Advantage
Plan ID: H7646-003
Provider: Php Medicare
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Michigan
Similar Plan:H7646-004


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
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Drug
Name⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Paliperidone
4$90$95NA30/30NN
Panretin
533%33%NAYN
Paricalcitol
4$90$95NANN
Paromomycin Sulfate
4$90$95NANN
Paroxetine
4$90$95NANN
Paroxetine Hydrochloride
4$90$95NA60/30NN
Paser
3$40$45NANN
Pediarix
3$40$45NANN
Pedvaxhib
3$40$45NANN
Peg-3350 And Electrolytes
2$0$10NANN
Peg-3350, Electrolytes, And Ascorbate
4$90$95NANN
Pegasys
533%33%NA2/28NN
Pemazyre
533%33%NA14/21YN
Penicillamine
533%33%NAYN
Penicillin G Potassium
4$90$95NAYN
Penicillin G Procaine
4$90$95NAYN
Penicillin G Sodium
4$90$95NAYN
Penicillin V Potassium
2$0$10NANN
Pentacel
3$40$45NANN
Pentamidine Isethionate
4$90$95NA1/28YN
Pentasa
533%33%NANN
Pentoxifylline
2$0$10NANN
Perindopril Erbumine
1$0$5NANN
Periogard Alcohol Free
1$0$5NANN
Permethrin
3$40$45NANN
Perphenazine
4$90$95NANN
Perseris
533%33%NA1/30NN
Phenelzine Sulfate
3$40$45NANN
Phenobarbital
3$40$45NAYN
Phenytoin
2$0$10NANN
Pifeltro
533%33%NANN
Pilocarpine Hydrochloride
3$40$45NANN
Pimecrolimus
4$90$95NA100/30YN
Pimozide
4$90$95NANN
Pindolol
3$40$45NANN
Piperacillin And Tazobactam
4$90$95NANN
Piqray
533%33%NAYN
Pirmella 1/35
2$0$10NANN
Piroxicam
3$40$45NANN
Plegridy
533%33%NA1/28YN
Plenamine
4$90$95NAYN
Podofilox
3$40$45NANN
Polyethylene Glycol 3350, Sodium Chloride, Sodium
2$0$10NANN
Polymyxin B Sulfate And Trimethoprim
2$0$10NANN
Portia
2$0$10NANN
Potassium Chloride
2$0$10NANN
Potassium Chloride In Dextrose
4$90$95NANN
Potassium Chloride In Dextrose And Sodium Chloride
4$90$95NANN
Potassium Chloride In Lactated Ringers And Dextros
4$90$95NANN
Potassium Chloride In Sodium Chloride
4$90$95NANN
Potassium Citrate
2$0$10NANN
Prasugrel
3$40$45NANN
Pravastatin Sodium
1$0$5NA30/30NN
Praziquantel
4$90$95NANN
Prazosin Hydrochloride
2$0$10NANN
Prednisolone Acetate
2$0$10NANN
Prednisolone Sodium Phosphate
2$0$10NANN
Prednisolone Sodium Phosphate Oral Solution
2$0$10NANN
Prednisone
1$0$5NANN
Prednisone Intensol
4$90$95NANN
Pregabalin
3$40$45NA900/30NN
Premarin
3$40$45NANN
Premasol - Sulfite-free (amino Acid)
4$90$95NAYN
Premphase
3$40$45NANN
Prempro
3$40$45NANN
Prevymis
533%33%NA30/30NN
Prezcobix
533%33%NANN
Prezista
533%33%NANN
Priftin
3$40$45NANN
Primaquine Phosphate
3$40$45NANN
Primidone
2$0$10NANN
Privigen
533%33%NAYN
Probenecid
3$40$45NANN
Probenecid And Colchicine
3$40$45NANN
Prochlorperazine Maleate
2$0$10NANN
Procrit
533%33%NAYN
Procto-med Hc
2$0$10NANN
Proctosol-hc
2$0$10NANN
Proctozone-hc
2$0$10NANN
Progesterone
2$0$10NANN
Prograf
4$90$95NAYN
Prolastin-c
533%33%NAYN
Prolensa
3$40$45NANN
Prolia
3$40$45NA1/180YN
Promacta
533%33%NAYN
Promethazine Hydrochloride
4$90$95NAYN
Propafenone Hydrochloride
4$90$95NANN
Propranolol Hydrochloride
2$0$10NANN
Propylthiouracil
2$0$10NANN
Proquad
3$40$45NANN
Protriptyline Hydrochloride
4$90$95NANN
Pulmicort
3$40$45NA1/30NN
Pulmozyme
533%33%NAYN
Purixan
533%33%NANN
Pyrazinamide
4$90$95NANN
Pyridostigmine Bromide
3$40$45NANN
Pyrimethamine
533%33%NAYN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H7646-003

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $0. 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.

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