Community First Medicare Advantage Alamo Plan (HMO) Formulary



Below is the 2023 Formulary, or prescription drug list, from Community First Medicare Advantage Alamo Plan (HMO) by Community First Health Plans, 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 Texas 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 Community First Medicare Advantage Alamo Plan (HMO)(H5447-001) plan has a $200 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. Community First Health Plans, 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:Community First Medicare Advantage Alamo Plan (HMO)
Plan ID: H5447-001
Provider: Community First Health Plans, Inc
Plan Year:2023
Premium:$0.00
Deductible:$200
Initial Coverage Limit:$4660
Coverage Area:Texas
Similar Plan:H5447-002


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
Deductible
Apply
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Cabergoline
1NNA$0NANN
Cablivi
5NA29%NA30/30YN
Cabometyx
5NA29%NA30/30YN
Calcipotriene
2NNA$7NA120/30YN
Calcitriol
1NNA$0NANN
Calcium Acetate
1NNA$0NANN
Calquence
5NA29%NA60/30YN
Camila
2NNA$7NANN
Camrese Lo
2NNA$7NANN
Candesartan
1NNA$0NANN
Caplyta
4YNA29%NA30/30YN
Caprelsa
5NA29%NA30/30YN
Captopril
2NNA$7NANN
Carbamazepine
2NNA$7NANN
Carbidopa
2NNA$7NANN
Carbidopa And Levodopa
1NNA$0NANN
Carbidopa, Levodopa, And Entacapone
2NNA$7NANN
Cardizem La
4YNA29%NANN
Carglumic Acid
1NNA$0NAYN
Carteolol Hydrochloride
1NNA$0NANN
Cartia
1NNA$0NANN
Caspofungin Acetate
2NNA$7NANN
Cayston
5NA29%NA84/28YN
Caziant
2NNA$7NANN
Cefaclor
4YNA29%NANN
Cefadroxil
1NNA$0NANN
Cefazolin
2NNA$7NANN
Cefdinir
1NNA$0NANN
Cefixime
2NNA$7NANN
Cefotetan
2NNA$7NANN
Cefoxitin
2NNA$7NANN
Cefpodoxime Proxetil
2NNA$7NANN
Cefprozil
1NNA$0NANN
Ceftazidime
2NNA$7NANN
Ceftriaxone Sodium
2NNA$7NANN
Cefuroxime
2NNA$7NANN
Celecoxib
1NNA$0NA60/30NN
Cellcept
4YNA29%NAYN
Celontin
3YNA$30NANN
Cephalexin
1NNA$0NANN
Cerdelga
5NA29%NA60/30YN
Cetraxal
3YNA$30NANN
Cevimeline
2NNA$7NANN
Chemet
3YNA$30NANN
Chenodal
5NA29%NANN
Chlordiazepoxide And Amitriptyline Hydrochloride
1NNA$0NANN
Chlordiazepoxide Hydrochloride
1NNA$0NA120/30NN
Chlorpromazine Hydrochloride
4YNA29%NANN
Chlorthalidone
1NNA$0NANN
Chlorzoxazone
3YNA$30NANN
Cholbam
5NA29%NAYN
Cholestyramine
1NNA$0NANN
Ciclopirox
2NNA$7NA120/30NN
Ciclopirox Olamine
1NNA$0NA60/30NN
Cilostazol
1NNA$0NANN
Ciloxan
4YNA29%NA7/7NN
Cimduo
5NA29%NANN
Cimetidine
1NNA$0NANN
Cimetidine Hydrochloride
1NNA$0NANN
Cimzia
5NA29%NA2/28YN
Cinacalcet Hydrochloride
2NNA$7NANN
Cinryze
5NA29%NAYN
Cipro
4YNA29%NANN
Ciprofloxacin
1NNA$0NANN
Ciprofloxacin And Dexamethasone
2NNA$7NANN
Ciprofloxacin Otic
3YNA$30NANN
Citalopram Hydrobromide
1NNA$0NANN
Claravis
2NNA$7NANN
Clarithromycin
3YNA$30NANN
Clenpiq
3YNA$30NANN
Cleocin
4YNA29%NANN
Clindacin Etz
1NNA$0NA120/30NN
Clindamycin
2NNA$7NANN
Clindamycin Hydrochloride
1NNA$0NANN
Clindamycin In 5 Percent Dextrose
2NNA$7NANN
Clindamycin Palmitate Hydrochloride (pediatric)
2NNA$7NANN
Clindamycin Phosphate
1NNA$0NANN
Clindamycin Phosphate And Benzoyl Peroxide
2NNA$7NA90/30NN
Clindesse
4YNA29%NANN
Clinimix
3YNA$30NAYN
Clinimix E
3YNA$30NAYN
Clobazam
2NNA$7NA480/30NN
Clobetasol Propionate
2NNA$7NA125/30NN
Clodan
2NNA$7NA236/30NN
Clomipramine Hydrochloride
2NNA$7NANN
Clonazepam
2NNA$7NA300/30NN
Clonidine Hydrochloride
1NNA$0NANN
Clonidine Transdermal System
2NNA$7NANN
Clorazepate Dipotassium
2NNA$7NA180/30NN
Clotrimazole
1NNA$0NANN
Clotrimazole And Betamethasone Dipropionate
2NNA$7NA60/30NN
Clozapine
2NNA$7NANN
Coartem
3YNA$30NANN
Codeine Sulfate
3YNA$30NA180/30NN
Colchicine
2NNA$7NANN
Colesevelam Hydrochloride
2NNA$7NANN
Colestipol Hydrochloride
1NNA$0NANN
Collagenase Santyl
3YNA$30NA90/30NN
Combipatch (estradiol/norethindrone Acetate Transd
4YNA29%NANN
Combivent Respimat
3YNA$30NANN
Complera
5NA29%NANN
Compro
1NNA$0NANN
Condylox
4YNA29%NA7/30NN
Corlanor
4YNA29%NAYN
Cotellic
5NA29%NA63/28YN
Creon
3YNA$30NANN
Crinone
3YNA$30NAYN
Cromolyn Sodium
1NNA$0NANN
Cryselle
2NNA$7NANN
Cyclobenzaprine Hydrochloride
1NNA$0NANN
Cyclophosphamide
3YNA$30NAYN
Cyclosporine
2NNA$7NAYN
Cyproheptadine Hydrochloride
1NNA$0NANN
Cyred Eq
2NNA$7NANN
Cystadrops
5NA29%NA20/28YN
Cystagon
3YNA$30NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H5447-001

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $200. 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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