Essence Dual Advantage (HMO D-SNP) Formulary



Below is the 2023 Formulary, or prescription drug list, from Essence Dual Advantage (HMO D-SNP) by Essence Healthcare, 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 Missouri 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 Essence Dual Advantage (HMO D-SNP)(H2610-017) 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. Essence Healthcare, 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:Essence Dual Advantage (HMO D-SNP)
Plan ID: H2610-017
Provider: Essence Healthcare, Inc
Plan Year:2023
Premium:$0.00
Deductible:$505
Initial Coverage Limit:$4660
Coverage Area:Missouri
Similar Plan:H2610-019


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
Edarbi
1YNA$0NANN
Edarbyclor
1YNA$0NANN
Edurant
1YNA$0NANN
Efavirenz
1YNA$0NANN
Efavirenz, Emtricitabine And Tenofovir Disoproxil
1YNA$0NANN
Efavirenz, Lamivudine And Tenofovir Disoproxil Fum
1YNA$0NANN
Egrifta Sv
1YNA$0NA30/30YN
Eligard
1YNA$0NAYN
Eliquis
1YNA$0NANN
Elmiron
1YNA$0NA90/30NN
Eluryng
1YNA$0NA1/28NN
Emcyt
1YNA$0NANN
Emend
1YNA$0NA6/28YN
Emgality
1YNA$0NA3/30YN
Emsam
1YNA$0NA30/30NY
Emtricitabine
1YNA$0NANN
Emtricitabine And Tenofovir Disoproxil Fumarate
1YNA$0NANN
Emtriva
1YNA$0NANN
Enalapril Maleate And Hydrochlorothiazide
1YNA$0NANN
Enalapril Maleate Oral Solution
1YNA$0NA1200/30NY
Enbrel
1YNA$0NAYN
Endocet
1YNA$0NA180/30NN
Engerix-b
1YNA$0NAYN
Enoxaparin Sodium
1YNA$0NA60/30NN
Enpresse
1YNA$0NANN
Enskyce
1YNA$0NANN
Enspryng
1YNA$0NAYN
Entacapone
1YNA$0NANN
Entecavir
1YNA$0NANN
Entresto
1YNA$0NA60/30NN
Enulose
1YNA$0NANN
Epclusa
1YNA$0NA28/28YN
Epidiolex
1YNA$0NAYN
Epinastine Hydrochloride
1YNA$0NANN
Epinephrine
1YNA$0NA4/30NN
Epitol
1YNA$0NANN
Epivir
1YNA$0NANN
Eplerenone
1YNA$0NANN
Eprontia
1YNA$0NA480/30NY
Ergoloid Mesylates
1YNA$0NANN
Erivedge
1YNA$0NA28/28YN
Erleada
1YNA$0NA120/30YN
Erlotinib
1YNA$0NA60/30YN
Errin
1YNA$0NANN
Ertapenem
1YNA$0NANN
Ery
1YNA$0NANN
Erythromycin
1YNA$0NA180/30NN
Erythromycin Ethylsuccinate
1YNA$0NANN
Esbriet
1YNA$0NA270/30YN
Escitalopram
1YNA$0NANN
Escitalopram Oxalate
1YNA$0NANN
Estarylla
1YNA$0NANN
Estazolam
1YNA$0NA30/30NN
Estradiol
1YNA$0NANN
Estradiol / Norethindrone Acetate
1YNA$0NANN
Estradiol Transdermal System
1YNA$0NA4/28NN
Estradiol Valerate
1YNA$0NANN
Eszopiclone
1YNA$0NA30/30NN
Ethambutol Hydrochloride
1YNA$0NANN
Ethosuximide
1YNA$0NANN
Ethynodiol Diacetate And Ethinyl Estradiol
1YNA$0NANN
Etodolac
1YNA$0NANN
Etonogestrel/ethinyl Estradiol
1YNA$0NA1/28NN
Etravirine
1YNA$0NANN
Everolimus
1YNA$0NA56/28YN
Evotaz
1YNA$0NANN
Evrysdi
1YNA$0NAYN
Exemestane
1YNA$0NANN
Exkivity
1YNA$0NA120/30YN
Eysuvis
1YNA$0NA/14NN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H2610-017

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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