Medica Prime Solution Basic w/Rx 2 (Cost) Formulary



Below is the 2023 Formulary, or prescription drug list, from Medica Prime Solution Basic w/Rx 2 (Cost) by Medica Insurance Company. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Minnesota 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 Medica Prime Solution Basic w/Rx 2 (Cost)(H2450-001) 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. Medica Insurance Company 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:Medica Prime Solution Basic w/Rx 2
Plan ID: H2450-001
Provider: Medica Insurance Company
Plan Year:2023
Premium:$83.60
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Minnesota
Similar Plan:H2450-002


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
3$35$47$35NN
Magnesium Sulfate
450%50%50%NN
Malathion
450%50%50%NN
Marlissa
2$8$20$8NN
Marplan
450%50%50%NN
Matulane
533%33%33%NN
Meclizine Hydrochloride
2$8$20$8NN
Medroxyprogesterone Acetate
2$8$20$8NN
Mefloquine Hydrochloride
2$8$20$8NN
Megestrol Acetate
3$35$47$35YN
Mekinist
533%33%33%30/30YN
Mektovi
533%33%33%180/30YN
Memantine
3$35$47$35YN
Memantine Hydrochloride
450%50%50%YN
Menactra
3$35$47$35NN
Menest
3$35$47$35YN
Menquadfi
3$35$47$35NN
Menveo
3$35$47$35NN
Mercaptopurine
3$35$47$35NN
Meropenem
450%50%50%30/10YN
Mesalamine
450%50%50%NN
Mesnex
533%33%33%NN
Metformin Hydrochloride
1$2$10$260/30NN
Methadone Hydrochloride
3$35$47$35120/30YN
Methazolamide
450%50%50%NN
Methenamine Hippurate
3$35$47$35NN
Methimazole
1$2$10$2NN
Methotrexate
2$8$20$8YN
Methoxsalen
533%33%33%NN
Methylphenidate Hydrochloride
450%50%50%NN
Methylphenidate Hydrochloride (la)
450%50%50%NN
Methylprednisolone
2$8$20$8YN
Metoclopramide
2$8$20$8NN
Metolazone
2$8$20$8NN
Metoprolol Succinate
1$2$10$2NN
Metoprolol Tartrate
1$2$10$2NN
Metoprolol Tartrate And Hydrochlorothiazide
2$8$20$8NN
Metronidazole
450%50%50%NN
Metyrosine
533%33%33%YN
Mexiletine Hydrochloride
3$35$47$35NN
Micafungin
533%33%33%NN
Mimvey
3$35$47$35YN
Minocycline
450%50%50%NN
Minocycline Hydrochloride
450%50%50%NN
Minoxidil
2$8$20$8NN
Mirtazapine
3$35$47$35NN
Moexipril Hydrochloride
1$2$10$2NN
Molindone Hydrochloride
450%50%50%NN
Mometasone Furoate
2$8$20$834/30NN
Montelukast Sodium
450%50%50%NN
Morphine Sulfate
3$35$47$35120/30YN
Motegrity
450%50%50%30/30NY
Movantik
3$35$47$3530/30NN
Moxifloxacin
3$35$47$35NN
Moxifloxacin Hydrochloride
450%50%50%YN
Mupirocin
2$8$20$844/30NN
Myalept
533%33%33%YN
Mycophenolate Mofetil
533%33%33%YN
Mycophenolic Acid
450%50%50%YN
Myrbetriq
3$35$47$35NN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H2450-001

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 $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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