Network Health Medicare Formulary

Benefits formulary pharmacy network and or copayments coinsurance may change on january 1 2021 and from time to time during the year.

Network health medicare formulary. On page 4 for information about. This list contains the drugs that network health covers under our health insurance plans. For additional information related to our network health medicare advantage plans and the medicare formulary see the medicare formulary information section under medicare plans pharmacy information. See the section how do i request an exception to the network health medicare advantage plan s formulary.

For more information on how to fill your prescriptions please review your evidence of coverage. Oct 4 2016 a formulary is a list of covered drugs selected by navitus the prescription is filled at a navitus medicarerx network pharmacy and other. Network health has a comprehensive list of covered drugs which is also referred to as a formulary or preferred drug list. The 2020 medicare formulary was last updated on september 1 2020.

Comprehensive formulary template 2017 indd montana health benefits mt gov. To do so you should submit a statement from your physician supporting your request. You can ask network health medicare advantage plans to make an exception to these restrictions or limits or for a list of other similar drugs that may treat your health condition. Providers and members should fax form to 1 866 388 1767.

Medicare part b pdf download network health formulary drug list. A prescription drug list pdl also called a formulary is a list of commonly used medications organized into cost levels called tiers. You can call us to ask for an exception submit your request by using the link below or fax or mail the form. It includes the most commonly covered medications with information about their tier and any restrictions or special requirements.

You may ask network health medicare advantage plans to make an exception to our prescription drug restrictions. These costs are decided by your employer or health plan. In addition the national committee for quality assurance ncqa awarded network health a 4 5 out of 5 rating for both medicare and commercial lines of business for 2019 2020. Health first health plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary the prescription is filled at a health first health plans network pharmacy and other plan rules are followed.

What is the fhcp medicare rx fhcp medicare rx plus fhcp medicare rx. Request for medicare prescription drug coverage determination use this printable form to ask us for a decision about a prescription drug and your specific plan coverage.