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Part D Prescription Drug Coverage

 

  • Formulary/Drug Lists and Drug Coverage

    A Formulary, sometimes called a Covered Drug List, is a list of prescription drugs generally covered by your MVP plan's pharmacy benefit. MVP will generally cover the drugs listed in our Formulary as long as the drug is medically necessary, the prescription is filled at an MVP network pharmacy, and other plan rules are followed.

    Individual Plan Formularies
    2018 Comprehensive Formulary
    2018 Abridged Formulary
    Formulary Changes

    Employer-Based Plan Formularies
    2018 Comprehensive Formulary
    2018 Abridged Formulary
    Formulary Changes

    Learn more about Part B drugs, diabetic supplies, and vaccine coverage

    Find information about drugs with restrictions and Formulary search tools.

    Learn More...

  • Find a Pharmacy

    Find a Participating Pharmacy for Medicare Part D
    2018 Medicare Advantage Pharmacy Directory

  • CVS Caremark

    CVS Caremark is the Pharmacy Benefits Manager and mail order vendor for MVP's Medicare Advantage plans with prescription drug coverage. This means they process your prescription drug claims. You do not need to go to a CVS/pharmacy for your prescriptions—you can fill your prescriptions at any pharmacy that contracts with MVP, including all major pharmacy chains. If you have questions about your prescription drug coverage, CVS Caremark Customer Care is available 24 hours a day, seven days a week at 1-866-494-8829 (TTY: 711).

    CVS Caremark Mail Service Pharmacy
    CVS Specialty Pharmacy

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  • Medication Therapy Management Program

    The Medication Therapy Management Program (MTMP) helps MVP Medicare Advantage plan members who have complex health needs or use multiple medications to treat chronic conditions better understand their prescriptions. This program is not considered a benefit and is offered at no cost to MVP Medicare Part D members.

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  • Coverage Determinations

    You can ask MVP to cover a drug for a lower cost, remove prior authorization, quantity limit, or step therapy requirements, or cover a drug that is not listed on the Formulary. This is called a coverage determination. All requests should include a statement from your prescriber or doctor supporting your request.

    Coverage Determination Forms
    Redetermination Form

    Learn More...

  • Help with Drug Costs

    There are programs that may help reduce your monthly prescription drug premium and drug co-pays. Learn more about Low Income Subsidy (LIS or Extra Help), New York State EPIC, Vermont VPharm, and Veterans Administration coverage.

    Learn More...

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    Frequently Asked Questions

    Get answers to questions about your Part D benefits, and more.

     

    Note:SmartFund™ MSA does not include Part D prescription drug coverage. The following information may not apply to all Medicare Part D members. Coverage and co-payments will vary if you qualify for low income subsidy (Extra Help) or if your coverage is through a former employer.

     

     

     

     

     

     

     

     

    Last updated October 2017

     

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2017 Part D Information

 

 

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Important Information

 

MVP Health Plan, Inc. is an HMO-POS/PPO/MSA organization with a Medicare contract. Enrollment in MVP Health Plan depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Medicare beneficiaries may also enroll in Preferred Gold HMO-POS, GoldValue HMO-POS, GoldSecure HMO-POS, Gold PPO, BasiCare PPO, and/or WellSelect PPO through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

 

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