Classic (HMO-POS), Value (HMO), Rewards (HMO), and SunSaver (HMO) plans
What is a Formulary?
A formulary is a comprehensive list of covered drugs selected by a team of healthcare providers as a part of a quality treatment program. 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. Documents on this page may be updated monthly.
Can the Formulary change?
Generally, if you are taking a drug on our current formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the current coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
Mail order pharmacies
- Mail order form:
- For filling new prescriptions from Health First Family Pharmacy (for more information, visit Health First Family Pharmacy).
Please see your Evidence of Coverage for the following information:
- How to get prescription drugs shipped to your home
- The amount of time it will take to receive your drugs
- If your a mail order is not received within the estimated timeframe, please contact Customer Service Representative
Forms
Prescription reimbursement form
Requirements
- Process for Part D prescription drug prior authorizations, exceptions, appeals and grievances
- Transition policy
- Medication Therapy Management
- Drug and/or Utilization Management
Extra help for prescription drug costs
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to 100% of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance.
Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. You may be able to get Extra Help to pay for your prescription drug premiums and costs.
To see if you qualify for getting Extra Help, call:
- 1.800.MEDICARE (1.800.633.4227). TTY/TDD users should call 1.877.486.2048, 24 hours a day/7days a week;
- The Social Security Administration at 1.800.772.1213 between 8 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1.800.325.0778; or
- Your local Social Security office.
- Your State Medicaid Office.
Assistance with Best Available Evidence for Low Income Subsidy
Health First Health Plans is an HMO plan with a Medicare Contract. Enrollment in Health First Health Plans depends on contract renewal.
Y0089_EL108008_M | Accepted date: 10/01/2023
Last updated: 04/08/2024