Neighborhood INTEGRITY (Medicare-Medicaid Plan) Formulary



Below is the 2023 Formulary, or prescription drug list, from Neighborhood INTEGRITY (Medicare-Medicaid Plan) by Neighborhood Health Plan Of Rhode Island. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Rhode Island 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 Neighborhood INTEGRITY (Medicare-Medicaid Plan)(H9576-001) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $NA. 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 $NA 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. Neighborhood Health Plan Of Rhode Island 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:Neighborhood INTEGRITY (Medicare-Medicaid Plan)
Plan ID: H9576-001
Provider: Neighborhood Health Plan Of Rhode Island
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$NA
Coverage Area:Rhode Island
Similar Plan:H9576-001


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
Nabumetone
1NA$0NANN
Nafcillin
1NA$0NANN
Naloxone Hydrochloride
1NA$0NANN
Namzaric
2NA$0NANN
Naproxen
1NA$0NA90/30NN
Naproxen Sodium
1NA$0NANN
Natacyn
2NA$0NANN
Natpara (parathyroid Hormone)
2NA$0NAYN
Nayzilam
2NA$0NANN
Nebivolol
1NA$0NA30/30NN
Nefazodone Hydrochloride
1NA$0NANN
Neomycin And Polymyxin B Sulfates And Bacitracin Z
1NA$0NANN
Neomycin And Polymyxin B Sulfates And Dexamethason
1NA$0NANN
Neomycin And Polymyxin B Sulfates And Gramicidin
1NA$0NANN
Neomycin And Polymyxin B Sulfates And Hydrocortiso
1NA$0NANN
Neomycin And Polymyxin B Sulfates, Bacitracin Zinc
1NA$0NANN
Neomycin Polymyxin B Sulfates And Dexamethasone
1NA$0NANN
Neomycin Sulfate
1NA$0NANN
Nerlynx
2NA$0NAYN
Neupro
2NA$0NANN
Nevirapine
1NA$0NANN
Nexavar
2NA$0NA120/30YN
Nicotrol
2NA$0NANN
Nifedipine
1NA$0NANN
Nikki
1NA$0NANN
Nilutamide
2NA$0NANN
Nimodipine
1NA$0NANN
Ninlaro
2NA$0NA3/28YN
Nitisinone
2NA$0NAYN
Nitrofurantoin Macrocrystals
2NA$0NANN
Nitrofurantoin Monohydrate/ Macrocrystalline
2NA$0NANN
Nitroglycerin
1NA$0NANN
Nitroglycerin Lingual
1NA$0NANN
Nizatidine
1NA$0NANN
Nora Be
1NA$0NANN
Norethindrone
1NA$0NANN
Norethindrone Acetate And Ethinyl Estradiol
2NA$0NANN
Norethindrone And Ethinyl Estradiol And Ferrous Fu
1NA$0NANN
Norgestimate And Ethinyl Estradiol
1NA$0NANN
Norpace Cr
2NA$0NANN
Nortrel
1NA$0NANN
Nortrel 7/7/7
1NA$0NANN
Nortriptyline Hydrochloride
2NA$0NANN
Norvir
2NA$0NANN
Novolin
2NA$0NANN
Novolog
2NA$0NANN
Novolog Mix 70/30
2NA$0NANN
Noxafil
2NA$0NA630/30YN
Nubeqa
2NA$0NAYN
Nurtec Odt
2NA$0NA16/30YN
Nuzyra
2NA$0NANN
Nylia 1/35
1NA$0NANN
Nylia 7/7/7
1NA$0NANN
Nystatin
1NA$0NA30/30NN
Nystop
1NA$0NA60/30NN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H9576-001

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