Prescription Drug Benefits
If you join Simply Healthcare Plans a Medicare Advantage Health Maintenance Organization (HMO) that offers Medicare prescription drug coverage, you must get your prescription drug coverage (Part D) through the plan's network pharmacies.
What are Medicare Part D Covered Drugs?
A Part D covered drug is available only by prescription, approved by the Food and Drug Administration (FDA) and used and sold in the United States. These medications are listed on the plan’s formulary.
Medicare covered Part D drugs include:
- Prescription drugs
- Biological products
- Insulin as defined by the Centers for Medicare and Medicaid Services (CMS)
- Certain vaccines
- Medical supplies associated with the injection of insulin such as syringes, needles, alcohol swabs, and gauze
Please use the links below for additional information regarding the plan’s prescription drug benefits.
- Formularies
- Transition Policy
- Utilization and Medical Management
- Coverage Determinations
- Potential for Contract Termination Notice
- What are Medicare Part B Covered Drugs?
- What are Tiers?
- Step Therapy
- Quantity Limits Day Supply
- Part D Prior Authorizations
- You can ask for an Exception
- Part D Coverage outside of the Service Area
- Out of Network
- How to Appoint a Representative
- Low Income Subsidy (LIS)
- Part D Grievances and Appeals
