MMM Balance (HMO-POS) Formulary



Below is the 2023 Formulary, or prescription drug list, from MMM Balance (HMO-POS) by Mmm Healthcare, Llc. 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 MMM Balance (HMO-POS)(H4004-063) 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. Mmm Healthcare, Llc 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:MMM Balance
Plan ID: H4004-063
Provider: Mmm Healthcare, Llc
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Puerto Rico
Similar Plan:H4004-065


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
3NA$3NANN
Magnesium Sulfate
2NANNANN
Malathion
2NANNANN
Marlissa
2NANNANN
Marplan
4NA$7NANN
Matulane
5NA25%NAYN
Mayzent
5NA25%NA30/30YN
Meclizine Hydrochloride
2NANNANN
Medroxyprogesterone Acetate
2NANNA1/90NN
Mefloquine Hydrochloride
2NANNANN
Megestrol Acetate
2NANNAYN
Mekinist
5NA25%NAYN
Mektovi
5NA25%NA180/30YN
Memantine
2NANNANN
Memantine Hydrochloride
2NANNA30/30NN
Menactra
3NA$3NANN
Menest
2NANNAYN
Menquadfi
3NA$3NANN
Menveo
3NA$3NANN
Meperidine Hydrochloride
2NANNA360/30NN
Mercaptopurine
2NANNANN
Meropenem
2NANNANN
Mesalamine
2NANNANN
Mesnex
5NA25%NANN
Metformin Hydrochloride
1NA$0NA60/30NN
Methadone Hydrochloride
2NANNA180/30NN
Methazolamide
2NANNANN
Methenamine Hippurate
2NANNANN
Methimazole
2NANNANN
Methotrexate
2NANNAYN
Methoxsalen
5NA25%NAYN
Methylphenidate Hydrochloride
2NANNA1800/30NN
Methylprednisolone
2NANNANN
Metoclopramide
2NANNANN
Metolazone
2NANNANN
Metoprolol Succinate
1NA$0NA60/30NN
Metoprolol Tartrate
1NA$0NANN
Metoprolol Tartrate And Hydrochlorothiazide
1NA$0NANN
Metronidazole
2NANNANN
Metyrosine
5NA25%NANN
Mexiletine Hydrochloride
2NANNANN
Micafungin
5NA25%NANN
Migergot
5NA25%NANN
Miglitol
2NANNA90/30NN
Miglustat
5NA25%NA90/30YN
Minocycline
2NANNANN
Minocycline Hydrochloride
2NANNANN
Minoxidil
2NANNANN
Mirtazapine
2NANNANN
Moexipril Hydrochloride
1NA$0NANN
Molindone Hydrochloride
2NANNANN
Mometasone Furoate
2NANNANN
Montelukast Sodium
1NA$0NA30/30NN
Morphine Sulfate
2NANNA90/30NN
Movantik
3NA$3NANN
Moxifloxacin
2NANNANN
Mupirocin
2NANNANN
Mycophenolate Mofetil
5NA25%NAYN
Mycophenolic Acid
2NANNAYN
Myrbetriq
4NA$7NA30/30NY

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H4004-063

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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