If your drug is contained in our non-preferred tier (Tier 3), you may ask us to cover it at the cost-sharing amount that applies to drugs in the preferred tier (Tier 2) subject to the tiering exceptions process. Coinsurance: You can use the search tools below to find out if your drugs are covered and which tier they fall under on your plan type. ©2021 Harvard Pilgrim Health Care, Inc. All rights reserved. BILHPN Pharmacy Newsletter; Newsletter Archives. To view the 2021 Cigna drug list: Choose a drug list from the drop down menu below to view medications that are commonly covered. Call (888) 333-4742 (TTY: 711). The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. This plan includes additional Medicare prescription drug (Part-D) coverage. Click a plan to look up drugs, get prices, find in-network pharmacies and more. If member purchases a brand drug Y0098_21113_M Accepted                          Last Update Date – 10/01/2020. Click a plan to look up drugs, get prices, find in-network pharmacies and more. Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. This guide provides a detailed explanation of the Medicare Part D drug coverage stages, what the "donut hole" is and how it factors into your out-of-pocket costs. MaineCare Preferred Diabetic Supply List- Effective January 1, 2021 200.76 KB 2020/12/31 MaineCare Preferred Diabetic Supply List- Effective July 1, 2020 171.08 KB Every drug in the formulary (drug list) has a tier number. Mail Order Prescriptions Mail order drugs are dispensed at 2x the retail prescription co-pay or cost share. If you do not see the druglist you need, please visit Prescription Drug Lists and Coverage If member purchases a brand drug Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, hospital services, accepted doctors and more. 2019 Harvard Pilgrim Stride Basic Rx (HMO) Formulary Below is the Formulary, or drug list, for Harvard Pilgrim Stride Basic Rx (HMO) from Harvard Pilgrim Health Care Of New England, Inc. *For HSA plans, deductible must be met first, excluding certain preventive drugs. SilverScript Medicare Part D formulary tiers indicate the level of cost-sharing for a covered drug. Harvard Pilgrim Stride Value Rx (HMO) H6750-002 is a 2019 Medicare Advantage or Medicare Part-C plan by Harvard Pilgrim Health Care of New England, Inc. available to residents in New Hampshire. Call (888) 333-4742 (TTY: 711). A deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. 2019 Harvard Pilgrim Stride Gain Rx (HMO) Formulary Below is the Formulary, or drug list, for Harvard Pilgrim Stride Gain Rx (HMO) from Harvard Pilgrim Health Care Of New England, Inc. Harvard Pilgrim Health Care POS $30/$50–$3,000/25% ACA Metal: Gold All plans are open access and contract year Harvard Pilgrim offers PPO plans. Monday - Friday 8 a.m.–8 p.m. 1–800–890–6600 (TTY: 711) Value 5-Tier Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. Need help with your account? Below is the Formulary, or drug list, for Harvard Pilgrim Stride Value Rx Plus (HMO) from Harvard Pilgrim Health Care Inc. Please bear with us as we work to upgrade this information to the same standards as the rest of our website. Member? 2019 Harvard Pilgrim Stride Basic Rx (HMO) Formulary. Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. Harvard Pilgrim is a leading not-for-profit health services company serving members in Connecticut, Maine, Massachusetts, New Hampshire and beyond. Cost-Sharing Tier 1: Preferred Generic Tier 1 is the lowest tier. The number of dollar or percentage amounts next to "Rx" on your card will tell you how many tiers your plan has. Premium 3-Tier The Harvard Pilgrim Stride Value Rx (HMO) plan has a $350 drug deductible. If you need drugs to treat your illness or condition More information about prescription drug coverage is ... Non-preferred brand drugs (Tier 3) Retail: 20% Coinsurance Mail Order: 20% . 2019 Harvard Pilgrim Stride Value Rx Plus (HMO) Formulary Below is the Formulary, or drug list, for Harvard Pilgrim Stride Value Rx Plus (HMO) from Harvard Pilgrim Health Care Of New England, Inc. * Not all employer-sponsored plans offer Harvard Pilgrim prescription drug benefits. In general, the higher the tier, the higher the member’s out-of-pocket cost for the covered drug. Southern Scripts a unique PBM model with three core components. Register now! Value 3-Tier ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. Below is the Formulary, or drug list, for Harvard Pilgrim Stride Basic Rx (HMO) from Harvard Pilgrim Health Care Inc. 2021 Prescription Drug Plans: Value 3-Tier Value 4-Tier Value 5-Tier Premium 3-Tier Premium 4-Tier Core NH 4-Tier Core NH 5-Tier * Not all employer-sponsored plans offer Harvard Pilgrim prescription drug benefits. Please contact Member Services or your Human Resources department to find out more about your coverage. The type of drug plan you have (either Premium, Value or Core NH) will be shown on your ID card. Please bear with us as we work to upgrade this information to the same standards as the rest of our website. In general, the lower the tier, the lower your cost for the drug. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC Tier 2 Preferred brand drugs 30% up to $50/script Tier 3 Non-preferred brand drugs 40% up to $250/script Tier 4 Specialty drugs 50% up to $750/script **For HSA plans, deductible must be met first, excluding certain preventive drugs. Harvard Pilgrim Health Care HSA $5,000/50% ACA Metal: Bronze All plans are open access and contract year. Contact Member Services at (888) 333-4742. Harvard Pilgrim Health Care and Tufts Health Plan Have Combined; Harvard Pilgrim Health Care-Tufts Health Plan Combination Finalized; Pharmacy Resources. Harvard Pilgrim Health Care StrideSM Basic Rx (HMO), StrideSM Value Rx (HMO), StrideSM Value Rx Plus (HMO), StrideSM Choice Rx (HMO-POS) and StrideSM Gain RxSM (HMO) 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary File ID#20231, Version Number This formulary is a list of prescription medications that are covered under Harvard Pilgrim Health Care … Core NH 5-Tier. ©2021 Harvard Pilgrim Health Care, Inc. All rights reserved. This formulary is a list of prescription medications that are covered under Harvard Pilgrim Health Care Inc.'s Medicare Advantage Plan in Massachusetts. You may ask us to provide a higher level of coverage for your drug. 2019 Harvard Pilgrim Stride Value Rx Plus (HMO) Formulary. Harvard Pilgrim offers PPO plans. If member purchases a brand drug The tier number determines the general cost of the drug. Harvard Pilgrim Health Care POS $35/$50–$4,000/50% ACA Metal: Silver All plans are open access and contract year Harvard Pilgrim offers PPO plans. 2019 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. If your card has dollar or percentage amounts next to "Rx" but does not say "Premium" or "Value", you have a Premium plan. Value 4-Tier Our goal is to provide employers with the right tools to achieve optimal health outcomes for their members by providing ideal access for prescription medications. Monday - Friday 8 a.m.–8 p.m. 1–800–890–6600 (TTY: 711) SilverScript plans use a system with five Medicare formulary tiers. Premium 4-Tier Our exceptional clinical quality and member satisfaction rate us consistently among the top plans in the co A formulary is a list of prescription medications that are covered under Harvard Pilgrim Health Care Inc.'s 2020 Medicare Advantage Plan in Massachusetts. 2020 Newsletter Archive; Newsletter Archives (2019, 2018 – prior to March 2018) The Coding Corner. Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. Tier 2 Preferred brand drugs 30% up to $50/script Tier 3 Non-preferred brand drugs 40% up to $250/script Tier 4 Specialty drugs 50% up to $750/script **For HSA plans, deductible must be met first, excluding certain preventive drugs. Plus, if the retail amount for a drug is lower than your copayment, you pay the lower amount. The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. Call us toll free. Core NH 4-Tier The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. The example shown is a Value 5-Tier plan. Get Health Insurance plan info on ElevateHealth Silver 3500 from Harvard Pilgrim Health Care of NE. Call us toll free. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 – 12/31/2019 Harvard University Medical Plan: Harvard Pilgrim Health Care (HPHC) HDHP Coverage for: Individual and Family Plan Type: PPO CovCover Coverage for: _____ | Plan Type: _____ 1 of 6 SBC #8 HPHC HDHP (Nonunion) You’ll find the tier number listed next to each drug. Create a secure account to see your personal health information.. Forgot password or username? Skip to content Skip to footer Harvard Pilgrim Health Care Close Menu Close Search Website These costs are decided by your employer or health plan. Your 2021 Premium Standard Formulary Effective January 1, 2021. Formulary lookup and preventive drug lists for Premium, Core NH, and Value formularies. Read more Prescription Drug … For the most current list of covered medications or if you have questions: Call the number on your member ID card. Harvard Pilgrim’s Pharmacy & Therapeutics (P&T) Committee is an advisory group comprised of Harvard Pilgrim clinical staff, as well as physician specialists, independent physicians, and pharmacy specialists who work together to promote clinically sound, cost-effective pharmaceutical care. Tufts Health Plan Medicare Preferred uses Formularies to list the prescription drugs that each of our different plan types cover. Harvard Pilgrim Health Care POS $30/$45–$1,800 ACA Metal: Gold All plans are open access and contract year Harvard Pilgrim offers PPO plans. A Prescription Drug List (PDL) – also called a formulary – is a list of commonly used medications, organized into cost levels, called tiers. If member purchases a brand drug Will tell you how many tiers your plan has a $ 350 deductible! All plans are open access and contract year read more prescription drug coverage, hospital services, accepted doctors more. Hsa $ 5,000/50 % ACA Metal: Bronze All plans are open access and contract year harvard pilgrim preferred drug list 2019 by your or... All employer-sponsored plans offer Harvard Pilgrim Stride Basic Rx ( HMO ) from Harvard Pilgrim Care... The lower amount are available to you free of charge on ElevateHealth Silver 3500 from Harvard Pilgrim Stride Rx. Mandatory Generic ) Generic substitution is required when available language assistance services available. 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