PHP (HMO C-SNP) Formulary



Below is the 2023 Formulary, or prescription drug list, from PHP (HMO C-SNP) by Ahf Mco Of Florida, 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 Florida 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 (HMO C-SNP)(H3132-001) plan has a $505 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. Ahf Mco Of Florida, 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:PHP (HMO C-SNP)
Plan ID: H3132-001
Provider: Ahf Mco Of Florida, Inc
Plan Year:2023
Premium:$0.00
Deductible:$505
Initial Coverage Limit:$4660
Coverage Area:Florida
Similar Plan:H3132-001


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
Deductible
Apply
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Paliperidone
1YNA15%NA30/30NN
Palynziq
4YNA25%NAYN
Panretin
4YNA25%NA180/30NN
Paricalcitol
1YNA15%NANN
Paromomycin Sulfate
1YNA15%NANN
Paroxetine
1YNA15%NAYN
Pediarix
2YNA15%NANN
Pedvaxhib
2YNA15%NANN
Pegasys
4YNA25%NANN
Pemazyre
4YNA25%NA14/21YN
Penicillamine
4YNA25%NAYN
Penicillin G Procaine
1YNA15%NANN
Penicillin V Potassium
1YNA15%NANN
Pentacel
2YNA15%NANN
Pentamidine Isethionate
1YNA15%NAYN
Pentoxifylline
1YNA15%NANN
Perindopril Erbumine
5NA$0NANN
Periogard Alcohol Free
1YNA15%NANN
Permethrin
1YNA15%NANN
Perphenazine
1YNA15%NANN
Perphenazine And Amitriptyline Hydrochloride
1YNA15%NANN
Perseris
4YNA25%NA1/30NN
Phenelzine Sulfate
1YNA15%NANN
Phenobarbital
1YNA15%NAYN
Phenytoin
1YNA15%NANN
Phoslyra
3YNA25%NANN
Pifeltro
4YNA25%NANN
Pilocarpine Hydrochloride
1YNA15%NANN
Pimecrolimus
1YNA15%NA100/30NN
Pimozide
1YNA15%NANN
Pindolol
1YNA15%NANN
Piperacillin And Tazobactam
1YNA15%NANN
Piqray
4YNA25%NA56/28YN
Pirmella 1/35
1YNA15%NANN
Piroxicam
1YNA15%NANN
Plegridy
4YNA25%NA1/28YN
Podofilox
1YNA15%NANN
Polyethylene Glycol 3350, Sodium Chloride, Sodium
1YNA15%NANN
Polymyxin B Sulfate And Trimethoprim
1YNA15%NANN
Portia
1YNA15%NANN
Potassium Chloride
1YNA15%NANN
Potassium Chloride In Sodium Chloride
1YNA15%NANN
Potassium Citrate
1YNA15%NANN
Prasugrel
1YNA15%NA30/30NN
Pravastatin Sodium
5NA$0NA30/30NN
Prazosin Hydrochloride
1YNA15%NANN
Prednisolone Acetate
3YNA25%NANN
Prednisolone Sodium Phosphate
1YNA15%NANN
Prednisolone Sodium Phosphate Oral Solution
1YNA15%NAYN
Prednisone
1YNA15%NANN
Pregabalin
1YNA15%NA900/30NN
Premarin
2YNA15%NAYN
Premphase
2YNA15%NAYN
Prempro
2YNA15%NAYN
Pretomanid
3YNA25%NA30/30NN
Prevymis
4YNA25%NA28/28YN
Prezcobix
4YNA25%NANN
Prezista
4YNA25%NANN
Priftin
3YNA25%NANN
Primaquine Phosphate
3YNA25%NANN
Primidone
1YNA15%NANN
Privigen
4YNA25%NAYN
Probenecid
1YNA15%NANN
Probenecid And Colchicine
1YNA15%NANN
Procalamine
3YNA25%NAYN
Prochlorperazine Maleate
1YNA15%NANN
Proctosol-hc
1YNA15%NANN
Proctozone-hc
1YNA15%NANN
Progesterone
1YNA15%NANN
Prograf
3YNA25%NAYY
Prolastin-c
4YNA25%NAYN
Prolensa
2YNA15%NANN
Prolia
2YNA15%NA1/180NN
Promacta
4YNA25%NA90/30YN
Promethazine Hydrochloride
1YNA15%NAYN
Propafenone Hydrochloride
1YNA15%NANN
Propranolol Hydrochloride
1YNA15%NANN
Propylthiouracil
1YNA15%NANN
Proquad
2YNA15%NANN
Prosol
3YNA25%NAYN
Protriptyline Hydrochloride
1YNA15%NANN
Pulmozyme
4YNA25%NAYN
Purified Cortrophin Gel
4YNA25%NA35/28YN
Purixan
4YNA25%NANN
Pyrazinamide
1YNA15%NANN
Pyridostigmine Bromide
1YNA15%NANN
Pyrimethamine
4YNA25%NAYN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H3132-001

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $505. 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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