MedicareMax (HMO) Formulary



Below is the 2023 Formulary, or prescription drug list, from MedicareMax (HMO) by Preferred Care Network, 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 MedicareMax (HMO)(H5420-001) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $5000. 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 $5000 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. Preferred Care Network, 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:MedicareMax
Plan ID: H5420-001
Provider: Preferred Care Network, Inc
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$5000
Coverage Area:Florida
Similar Plan:H5420-003


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
M-m-r Ii
3NA$0NA1/1NN
Magnesium Sulfate
4NA$65NANN
Malathion
4NA$65NANN
Marlissa
4NA$65NANN
Marplan
4NA$65NANN
Matulane
5NA33%33%NN
Mavyret
5NA33%33%140/28YN
Mayzent
5NA33%33%30/30NN
Meclizine Hydrochloride
2NANNANN
Medroxyprogesterone Acetate
4NA$65NANN
Mefloquine Hydrochloride
2NANNANN
Megestrol Acetate
3NA$0NANN
Mekinist
5NA33%33%YN
Mektovi
5NA33%33%YN
Memantine
4NA$65NA300/30YN
Memantine Hydrochloride
3NA$0NA30/30YN
Menactra
3NA$0NA0/1NN
Menest
3NA$0NANN
Menquadfi
3NA$0NA0/1NN
Menveo
3NA$0NA1/1NN
Mercaptopurine
3NA$0NANN
Meropenem
4NA$65NANN
Mesalamine
3NA$0NA120/30NN
Mesnex
4NA$65NANN
Metformin Hydrochloride
1NA$0NA60/30NN
Metformin Hydrochloride Oral Solution
1NA$0NA765/30NN
Methadone Hydrochloride
3NA$0NA360/30NN
Methazolamide
4NA$65NANN
Methenamine Hippurate
3NA$0NANN
Methimazole
1NA$0NANN
Methocarbamol
3NA$0NA540/365NN
Methotrexate
2NANNANN
Methoxsalen
5NA33%33%NN
Methscopolamine Bromide
4NA$65NANN
Methylphenidate Hydrochloride
4NA$65NA1800/30NN
Methylprednisolone
2NANNANN
Metoclopramide
2NANNANN
Metolazone
1NA$0NANN
Metoprolol Succinate
1NA$0NANN
Metoprolol Tartrate
1NA$0NANN
Metoprolol Tartrate And Hydrochlorothiazide
2NANNANN
Metronidazole
4NA$65NANN
Metyrosine
5NA33%33%NN
Mexiletine Hydrochloride
3NA$0NANN
Micafungin
4NA$65NANN
Miconazole Nitrate
3NA$0NANN
Migergot
5NA33%33%NN
Miglitol
4NA$65NA90/30NN
Miglustat
5NA33%33%YN
Minocycline
4NA$65NANN
Minocycline Hydrochloride
4NA$65NANN
Minoxidil
2NANNANN
Mirtazapine
2NANNANN
Moexipril Hydrochloride
1NA$0NA60/30NN
Molindone Hydrochloride
4NA$65NANN
Mometasone Furoate
4NA$65NANN
Montelukast Sodium
2NANNA30/30NN
Morphine Sulfate
4NA$65NA60/30NN
Motegrity
4NA$65NA30/30NN
Movantik
3NA$0NA30/30NN
Moxifloxacin
4NA$65NANN
Moxifloxacin Hydrochloride
4NA$65NANN
Mupirocin
2NANNA110/30NN
Myalept
5NA33%33%YN
Mycophenolate Mofetil
5NA33%33%YN
Mycophenolic Acid
4NA$65NAYN
Myrbetriq
3NA$0NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H5420-001

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $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 $5000
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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