MCS Classicare Platino Total (HMO D-SNP) Formulary



Below is the 2023 Formulary, or prescription drug list, from MCS Classicare Platino Total (HMO D-SNP) by Mcs Advantage, 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 Puerto Rico 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 MCS Classicare Platino Total (HMO D-SNP)(H5577-046) 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. Mcs Advantage, 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:MCS Classicare Platino Total (HMO D-SNP)
Plan ID: H5577-046
Provider: Mcs Advantage, Inc
Plan Year:2023
Premium:$0.00
Deductible:$505
Initial Coverage Limit:$4660
Coverage Area:Puerto Rico
Similar Plan:H5577-047


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
M-m-r Ii
3YNA$0NANN
Magnesium Sulfate
1YNA$0NANN
Malathion
2YNANNANN
Marplan
4YNA$0NANN
Matulane
5NA$0NAYN
Mavyret
5NA$0NAYN
Mayzent
5NA$0NA30/30YN
Meclizine Hydrochloride
1YNA$0NANN
Medroxyprogesterone Acetate
2YNANNA1/90NN
Mefloquine Hydrochloride
2YNANNANN
Megestrol Acetate
2YNANNAYN
Mekinist
5NA$0NAYN
Mektovi
5NA$0NAYN
Memantine
2YNANNA300/30NN
Memantine Hydrochloride
2YNANNA30/30NN
Menactra
3YNA$0NANN
Menest
4YNA$0NANN
Menquadfi
3YNA$0NANN
Menveo
3YNA$0NANN
Mercaptopurine
2YNANNANN
Meropenem
2YNANNANN
Mesalamine
2YNANNA120/30NN
Mesnex
5NA$0NANN
Metformin Hydrochloride
1YNA$0NA60/30NN
Metformin Hydrochloride Oral Solution
2YNANNANN
Methadone Hydrochloride
2YNANNA180/30NN
Methazolamide
2YNANNANN
Methenamine Hippurate
2YNANNANN
Methimazole
1YNA$0NANN
Methotrexate
1YNA$0NAYN
Methylphenidate Hydrochloride
2YNANNA90/30NN
Methylprednisolone
2YNANNANN
Metoclopramide
1YNA$0NANN
Metolazone
2YNANNANN
Metoprolol Succinate
1YNA$0NANN
Metoprolol Tartrate
1YNA$0NANN
Metoprolol Tartrate And Hydrochlorothiazide
2YNANNANN
Metronidazole
2YNANNANN
Metyrosine
5NA$0NANN
Mexiletine Hydrochloride
2YNANNANN
Micafungin
5NA$0NANN
Miconazole Nitrate
2YNANNANN
Miglitol
2YNANNA90/30NN
Miglustat
5NA$0NAYN
Minocycline
2YNANNANN
Minocycline Hydrochloride
2YNANNANN
Minoxidil
1YNA$0NANN
Mirtazapine
2YNANNA30/30NN
Moexipril Hydrochloride
1YNA$0NANN
Molindone Hydrochloride
2YNANNANN
Mometasone Furoate
2YNANNANN
Montelukast Sodium
2YNANNA30/30NN
Morphine Sulfate
2YNANNA120/30NN
Movantik
3YNA$0NA30/30NN
Moxifloxacin
2YNANNANN
Mupirocin
1YNA$0NA352/30NN
Mycophenolate Mofetil
5NA$0NAYN
Mycophenolic Acid
2YNANNAYN
Myrbetriq
3YNA$0NA300/30NN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H5577-046

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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