Wellcare Dual Liberty (HMO D-SNP) Formulary



Below is the 2023 Formulary, or prescription drug list, from Wellcare Dual Liberty (HMO D-SNP) by Wellcare Of Connecticut, 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 Connecticut 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 Wellcare Dual Liberty (HMO D-SNP)(H0712-029) 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. Wellcare Of Connecticut, 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:Wellcare Dual Liberty (HMO D-SNP)
Plan ID: H0712-029
Provider: Wellcare Of Connecticut, Inc
Plan Year:2023
Premium:$0.00
Deductible:$505
Initial Coverage Limit:$4660
Coverage Area:Connecticut
Similar Plan:H0712-005


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
Labetalol Hcl
1YNA$0NANN
Lamivudine
1YNA$0NANN
Lamotrigine
1YNA$0NANN
Lansoprazole
1YNA$0NANN
Lantus
1YNA$0NANN
Lapatinib
1YNA$0NAYN
Larissia
1YNA$0NANN
Latanoprost
1YNA$0NANN
Layolis Fe
1YNA$0NANN
Leena
1YNA$0NANN
Leflunomide
1YNA$0NA30/30NN
Lenvima
1YNA$0NA90/30YN
Lessina
1YNA$0NANN
Leucovorin Calcium
1YNA$0NANN
Leukeran
1YNA$0NANN
Leuprolide Acetate
1YNA$0NAYN
Levalbuterol
1YNA$0NAYN
Levalbuterol Hydrochloride
1YNA$0NAYN
Levalbuterol Tartrate Hfa Inhalation
1YNA$0NA30/30NY
Levemir
1YNA$0NANN
Levetiracetam
1YNA$0NANN
Levo-t
1YNA$0NANN
Levobunolol Hydrochloride
1YNA$0NANN
Levocarnitine
1YNA$0NAYN
Levocetirizine Dihydrochloride
1YNA$0NANN
Levofloxacin
1YNA$0NANN
Levonorgestrel And Ethinyl Estradiol
1YNA$0NANN
Levonorgestrel And Ethinyl Estradiol And Ethinyl E
1YNA$0NANN
Levora
1YNA$0NANN
Levothyroxine Sodium
1YNA$0NANN
Levoxyl
1YNA$0NANN
Lexiva
1YNA$0NANN
Lidocaine
1YNA$0NA50/30YN
Lidocaine Hydrochloride
1YNA$0NANN
Linezolid
1YNA$0NA1800/30NN
Lisinopril
1YNA$0NANN
Lithium Carbonate
1YNA$0NANN
Livalo
1YNA$0NA30/30NY
Loestrin
1YNA$0NANN
Lokelma
1YNA$0NANN
Lonsurf
1YNA$0NAYN
Loperamide Hydrochloride
1YNA$0NANN
Lopinavir And Ritonavir
1YNA$0NANN
Lopinavir-ritonavir
1YNA$0NANN
Lorazepam
1YNA$0NA150/30NN
Lorbrena
1YNA$0NAYN
Loryna
1YNA$0NANN
Low-ogestrel
1YNA$0NANN
Loxapine
1YNA$0NANN
Lubiprostone
1YNA$0NA60/30NN
Lupron Depot
1YNA$0NAYN
Lutera
1YNA$0NANN
Lyleq
1YNA$0NANN
Lyllana
1YNA$0NANN
Lynparza
1YNA$0NA120/30YN
Lyrica Cr
1YNA$0NA60/30YN
Lysodren
1YNA$0NANN
Lyza
1YNA$0NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H0712-029

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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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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