Western Health Advantage MyCare Compass (HMO) Formulary



Below is the 2023 Formulary, or prescription drug list, from Western Health Advantage MyCare Compass (HMO) by Western Health Advantage. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a California 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 Western Health Advantage MyCare Compass (HMO)(H2782-004) 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. Western Health Advantage 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:Western Health Advantage MyCare Compass
Plan ID: H2782-004
Provider: Western Health Advantage
Plan Year:2023
Premium:$20.00
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:California
Similar Plan:H2782-002


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
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Labetalol Hcl
2$5$10NANN
Lamivudine
4$100$100NANN
Lamotrigine
3$40$47NANN
Lansoprazole
2$5$10NANN
Lansoprazole, Amoxicillin And Clarithromycin
4$100$100NANN
Lanthanum Carbonate
4$100$100NANN
Lantus
3$40$47NANN
Lapatinib
533%33%NAYN
Larissia
3$40$47NANN
Latanoprost
1$0$0NANN
Ledipasvir And Sofosbuvir
533%33%NAYN
Leena
3$40$47NANN
Leflunomide
3$40$47NANN
Lenvima
533%33%NAYN
Lessina
3$40$47NANN
Leucovorin Calcium
3$40$47NANN
Leukeran
533%33%NANN
Leukine
533%33%NANN
Leuprolide Acetate
4$100$100NANN
Levalbuterol
4$100$100NAYN
Levalbuterol Hydrochloride
4$100$100NAYN
Levalbuterol Tartrate Hfa Inhalation
4$100$100NANN
Levetiracetam
2$5$10NANN
Levo-t
3$40$47NANN
Levobunolol Hydrochloride
2$5$10NANN
Levocarnitine
3$40$47NAYN
Levocetirizine Dihydrochloride
4$100$100NANN
Levofloxacin
4$100$100NANN
Levonorgestrel And Ethinyl Estradiol
3$40$47NANN
Levora
3$40$47NANN
Levorphanol Tartrate
533%33%NA4/1YN
Levothyroxine Sodium
1$0$0NANN
Levoxyl
3$40$47NANN
Lexiva
3$40$47NANN
Lidocaine
3$40$47NAYN
Lidocaine Hydrochloride
2$5$10NANN
Lindane
4$100$100NANN
Linezolid
533%33%NANN
Lisinopril
1$0$0NANN
Lithium Carbonate
2$5$10NANN
Lonsurf
533%33%NAYN
Loperamide Hydrochloride
2$5$10NANN
Lopinavir And Ritonavir
533%33%NANN
Lopinavir-ritonavir
4$100$100NANN
Lorazepam
2$5$10NANN
Lorbrena
533%33%NAYN
Loryna
3$40$47NANN
Loteprednol Etabonate
3$40$47NANN
Low-ogestrel
3$40$47NANN
Loxapine
2$5$10NANN
Lubiprostone
3$40$47NANN
Lupron Depot
533%33%NAYN
Lutera
3$40$47NANN
Lyleq
3$40$47NANN
Lyllana
4$100$100NANN
Lynparza
533%33%NAYN
Lysodren
533%33%NANN
Lyza
3$40$47NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H2782-004

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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