Covered medications
The formulary below is a listing of prescription drugs that are covered by NaviCare HMO SNP. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy and other plan rules are followed. The formulary was last updated on October 1, 2009. It is subject to change at any time.
Changes to the list of covered medications
You may view the PDF documents below to see if there are changes to the 2010 NaviCare list of covered medications. If there are no documents listed below, then there are currently no changes to the list of covered medications.
| Drug name |
Date of notice |
Effective date |
Reason for change |
| |
|
|
|
My drug isn't on the covered medications list. What can I do?
Drug transition policy
As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary, but your ability to get it is limited. This policy explains how we can help you transition your drugs.
Request for Medicare prescription drug coverage determination form (pdf, 74 KB)
Use this form for you to request an exception or coverage determination.
Medicare Part D coverage determination request form (pdf, 74 KB)
The provider who prescribes your drugs may use this form to request an exception or coverage determination.
Other important information about medications
Medication Therapy Management Program
The Medication Therapy Management (MTM) Program is a free service that we may offer through NaviCare. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate, but it is recommended that you take full advantage of this covered service if you are selected.
To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer.
Adobe is a registered trademark of Adobe Systems Incorporated.