Preferred Medicare Assist (HMO D-SNP) Formulary



Below is the 2023 Formulary, or prescription drug list, from Preferred Medicare Assist (HMO D-SNP) by Preferred Care Partners, 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 Preferred Medicare Assist (HMO D-SNP)(H1045-012) 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. Preferred Care Partners, 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:Preferred Medicare Assist (HMO D-SNP)
Plan ID: H1045-012
Provider: Preferred Care Partners, Inc
Plan Year:2023
Premium:$35.90
Deductible:$505
Initial Coverage Limit:$4660
Coverage Area:Florida
Similar Plan:H1045-018


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
4YNA15%NA30/30NN
Panretin
5NA15%NAYN
Panzyga
5NA15%NAYN
Paricalcitol
4YNA15%NAYN
Paromomycin Sulfate
4YNA15%NANN
Paroxetine
4YNA15%NANN
Paser
4YNA15%NANN
Pediarix
3YNA15%NA0/1NN
Pedvaxhib
3YNA15%NA0/1NN
Peg-3350 And Electrolytes
2YNA15%NANN
Pegasys
5NA15%NAYN
Pemazyre
5NA15%NA14/21YN
Penicillamine
5NA15%NAYN
Penicillin G Procaine
4YNA15%NANN
Penicillin G Sodium
4YNA15%NANN
Penicillin V Potassium
2YNA15%NANN
Pentacel
3YNA15%NA1/1NN
Pentamidine Isethionate
4YNA15%NA1/28YN
Pentasa
4YNA15%NA480/30NN
Pentoxifylline
2YNA15%NANN
Perindopril Erbumine
1YNA15%NA60/30NN
Periogard Alcohol Free
1YNA15%NANN
Permethrin
3YNA15%NANN
Perphenazine
4YNA15%NANN
Perseris
5NA15%NANN
Phenelzine Sulfate
3YNA15%NANN
Phenobarbital
2YNA15%NANN
Phenoxybenzamine Hydrochloride
5NA15%NANN
Phenytek
2YNA15%NANN
Phenytoin
2YNA15%NANN
Phoslyra
3YNA15%NANN
Pifeltro
5NA15%NA30/30NN
Pilocarpine Hydrochloride
3YNA15%NANN
Pimecrolimus
4YNA15%NA100/30NY
Pimozide
4YNA15%NANN
Pindolol
3YNA15%NANN
Pioglitazone And Glimepiride
1YNA15%NA30/30NN
Piperacillin And Tazobactam
4YNA15%NANN
Piqray
5NA15%NA56/28YN
Pirmella 1/35
4YNA15%NANN
Piroxicam
3YNA15%NANN
Plenamine
4YNA15%NAYN
Podofilox
3YNA15%NANN
Polyethylene Glycol 3350, Sodium Chloride, Sodium
2YNA15%NANN
Polymyxin B Sulfate And Trimethoprim
2YNA15%NANN
Portia
4YNA15%NANN
Potassium Chloride
1YNA15%NANN
Potassium Chloride In Dextrose
4YNA15%NAYN
Potassium Chloride In Dextrose And Sodium Chloride
4YNA15%NANN
Potassium Chloride In Lactated Ringers And Dextros
4YNA15%NANN
Potassium Chloride In Sodium Chloride
4YNA15%NAYN
Potassium Citrate
3YNA15%NANN
Prasugrel
3YNA15%NA30/30NN
Pravastatin Sodium
1YNA15%NA30/30NN
Praziquantel
4YNA15%NANN
Prazosin Hydrochloride
2YNA15%NANN
Pred Mild
4YNA15%NANN
Pred-g
4YNA15%NANN
Prednisolone Acetate
3YNA15%NANN
Prednisolone Sodium Phosphate
2YNA15%NANN
Prednisolone Sodium Phosphate Oral Solution
2YNA15%NANN
Prednisone
1YNA15%NANN
Prednisone Intensol
2YNA15%NANN
Pregabalin
3YNA15%NA900/30NN
Premarin
4YNA15%NA30/30NN
Premasol - Sulfite-free (amino Acid)
4YNA15%NAYN
Premphase
4YNA15%NA28/28NN
Prempro
4YNA15%NA28/28NN
Prevymis
5NA15%NA28/28YN
Prezcobix
5NA15%NA30/30NN
Prezista
5NA15%NA30/30NN
Priftin
4YNA15%NANN
Primaquine Phosphate
4YNA15%NANN
Primidone
2YNA15%NANN
Privigen
5NA15%NAYN
Proair
3YNA15%NANN
Proair Respiclick
3YNA15%NANN
Probenecid
3YNA15%NANN
Probenecid And Colchicine
3YNA15%NANN
Procalamine
4YNA15%NAYN
Prochlorperazine Maleate
2YNA15%NANN
Procrit
5NA15%NAYN
Procto-med Hc
2YNA15%NANN
Proctosol-hc
2YNA15%NANN
Proctozone-hc
2YNA15%NANN
Procysbi
5NA15%NANN
Progesterone
2YNA15%NANN
Prograf
4YNA15%NAYN
Prolastin-c
5NA15%NAYN
Prolensa
4YNA15%NANN
Prolia
4YNA15%NA1/180NN
Promacta
5NA15%NA180/30YN
Promethazine Hydrochloride
3YNA15%NANN
Propafenone Hydrochloride
4YNA15%NANN
Propranolol Hydrochloride
2YNA15%NANN
Propylthiouracil
2YNA15%NANN
Proquad
3YNA15%NA1/1NN
Prosol
4YNA15%NAYN
Protriptyline Hydrochloride
4YNA15%NANN
Pulmozyme
5NA15%NA150/30YN
Purixan
5NA15%NAYN
Pyrazinamide
4YNA15%NANN
Pyridostigmine Bromide
5NA15%NANN
Pyrimethamine
5NA15%NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H1045-012

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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