Part D Prescription Drug Coverage
MVP’s Medicare Advantage plans offer the convenience of both medical coverage and Part D prescription drug coverage together in one plan, and with one convenient monthly bill.
Note: If you do not join a Medicare Part D plan when you first become eligible for Medicare, or do not have coverage as good as Medicare’s, you may have to pay a penalty if you join at a later date. The penalty can be 1% of the current premium for every month you delay enrollment. This penalty will apply for as long as you are enrolled in Part D coverage. Learn more.
Programs that may help you save money
- Check anytime to see if you are eligible for help from a State Pharmacy Assistance Program.
- In New York State, call EPIC (Elderly Pharmaceutical Insurance Coverage) program at 1-800-332-3742.
- In Vermont, call the Vermont Prescription Assistance program at 1-800-250-8427.
- Check anytime to see if you are eligible to receive Extra Help with prescriptions (called Low Income Subsidy).
- Call the Social Security Administration Office at 1-800-772-1213. TTY: 1-800-325-0778.
- In New York you can also call the New York State Health Insurance Information, Counseling and Assistance Program at 1-800-333-4114.
- In Vermont, call the Area Agency on Aging of Vermont at 1-800-552-3402.
Generic drugs at low or no cost!
Generic drugs have the same active ingredients, strength, and effectiveness as the brand-name versions, but generally at a much lower cost. What could you save? A lot.
- View the list of MVP Preferred Generic Drugs.
- Check for generic drug and select vaccine pricing on the MVP plan you choose.
MVP’s coverage for medically necessary Medicare Part D approved drugs includes:
- Tier 1 – Preferred Generic Drugs
- Tier 2 – Generic Drugs
- Tier 3 – Preferred Brand Name Drugs
- Tier 4 – Non-Preferred Brand Drugs
- Tier 5 – Specialty Drugs
- Tier 6 – Vaccines
Depending on which MVP Medicare Advantage plan you choose, Tier 1 and Tier 6 drugs are available at $0 or no more than $3 during the Deductible Stage and Initial Coverage Stage.
Note: Tier 1 and Tier 6 drugs do not count toward the $360 deductible on the BasiCare with Part D PPO plan. You will pay $3 for Tier 1 drugs, $0 for Tier 6 drugs and 100% for drugs in Tiers 2 – 5 until you spend $360.
Part D drugs excluded from MVP’s Part D Formulary must go through an exception process in order for MVP to cover them. If they are approved, they will be covered in Tier 4.
Coverage in the Gap
If your total drug costs in 2016 reach $3,310, you will pay 58% for generic drugs and 45% for Medicare-contracted brands. When your out-of-pocket drug costs reach $4,805 in 2016, your cost for prescriptions is reduced to the greater of 5% or $2.95 for generics and $7.40 for brand-name drugs. In addition:
If you choose GoldValue with Part D, Preferred Gold with Part D or Gold PPO with Part D and are taking a Tier 1 drug or Tier 6 drug, you will pay $0 during the Coverage Gap.
If you choose BasiCare with Part D PPO and are taking a Tier 1 drug or Tier 6 drug, yo will pay 58% for generic drugs and 45% for Medicare-contracted brands during the Coverage Gap.
Medicare Advantage Part D Covered Drugs and Pharmacy Directory
To learn more about our pharmacy programs visit our main site at www.mvphealthcare.com/medicare. For information about how to request a formulary exception, an expedited exception or other utilization management exceptions, go to www.mvphealthcare.com/medicare/PartD/partd_pharm_mgmt.html.
For your convenience, you can also call:
1-800-324-3899 TTY: 1-800-662-1220
Experienced MVP Medicare Products Advisors are available Monday – Friday, 8 am to 8 pm Eastern Time.
Or call the MVP Medicare Customer Care Center Monday – Friday, 8 am – 8 pm at 1-800-665-7924 (TTY: 1-800-662-1220).
From October 1 – February 14, call us every day from 8 am to 8 pm.