Elixir RxPlus (PDP) Formulary



Below is the 2023 Formulary, or prescription drug list, from Elixir RxPlus (PDP) by Elixir Insurance Company. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a In Indiana, Kentucky. 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 Elixir RxPlus (PDP)(S7694-133) 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. Elixir Insurance Company 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:Elixir RxPlus (PDP)
Plan ID: S7694-133
Formulary
Provider: Elixir Insurance Company
Plan Year:2023
Premium:$41.40
Deductible:$505
Initial Coverage Limit:$4660
Coverage Area:Indiana, Kentucky
Similar Plan:S7694-134


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
Edurant
525%25%25%30/30NN
Efavirenz
4Y47%50%47%30/30NN
Efavirenz, Emtricitabine And Tenofovir Disoproxil
525%25%25%30/30NN
Efavirenz, Lamivudine And Tenofovir Disoproxil Fum
525%25%25%30/30NN
Eligard
4Y47%50%47%YN
Eliquis
3Y$43$47$4374/30NN
Emcyt
4Y47%50%47%NN
Emend
4Y47%50%47%YN
Emgality
3Y$43$47$432/30YN
Emsam
525%25%25%30/30YN
Emtricitabine
4Y47%50%47%30/30NN
Emtricitabine And Tenofovir Disoproxil Fumarate
525%25%25%30/30NN
Emtriva
4Y47%50%47%680/28NN
Enalapril Maleate And Hydrochlorothiazide
2N$6$16$6NN
Enbrel
525%25%25%8/28YN
Endocet
4Y47%50%47%370/30NN
Engerix-b
3Y$43$47$43YN
Enoxaparin Sodium
4Y47%50%47%60/30NN
Enpresse
4Y47%50%47%NN
Enskyce
4Y47%50%47%NN
Entacapone
4Y47%50%47%NN
Entecavir
4Y47%50%47%30/30NN
Entresto
3Y$43$47$4360/30NN
Enulose
2N$6$16$6NN
Epclusa
525%25%25%YN
Epidiolex
525%25%25%600/30YN
Epinephrine
3Y$43$47$434/30NN
Epitol
3Y$43$47$43NN
Epivir
4Y47%50%47%NN
Eplerenone
4Y47%50%47%NN
Eprontia
4Y47%50%47%NN
Ergotamine Tartrate And Caffeine
3Y$43$47$4340/28NN
Erivedge
525%25%25%28/28YN
Erleada
525%25%25%120/30YN
Erlotinib
525%25%25%90/30YN
Errin
4Y47%50%47%NN
Ertapenem
4Y47%50%47%NN
Ery-tab
4Y47%50%47%NN
Erythrocin Lactobionate
4Y47%50%47%NN
Erythrocin Stearate
4Y47%50%47%NN
Erythromycin
4Y47%50%47%NN
Erythromycin Ethylsuccinate
4Y47%50%47%NN
Esbriet
525%25%25%270/30YN
Escitalopram
2N$6$16$645/30NN
Escitalopram Oxalate
4Y47%50%47%600/30NN
Estarylla
4Y47%50%47%NN
Estradiol
2N$6$16$6NN
Estradiol Transdermal System
4Y47%50%47%4/28NN
Estradiol Valerate
4Y47%50%47%NN
Ethambutol Hydrochloride
3Y$43$47$43NN
Ethosuximide
4Y47%50%47%NN
Ethynodiol Diacetate And Ethinyl Estradiol
4Y47%50%47%NN
Etodolac
4Y47%50%47%NN
Etravirine
525%25%25%60/30NN
Euthyrox
2N$6$16$6NN
Everolimus
525%25%25%30/30YN
Evotaz
525%25%25%30/30NN
Exemestane
4Y47%50%47%NN
Exkivity
525%25%25%120/30YN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for S7694-133

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 2022 is $320. 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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HealthCompare Insurance Services, HealthPlanOne, LLC, ClearMatch Medicare and Medicare Solutions does not offer every plan available in your area. Currently HealthCompare Insurance Services represent 18 organizations, which offers 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. HealthCompare Insurance Services, HealthPlanOne, LLC, ClearMatch Medicare and Medicare Solutions represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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