What is a formulary? A formulary is a list of covered drugs selected by Vantage
Medicare Advantage in consultation with a team of health care providers, which represents
the prescription therapies believed to be a necessary part of a quality treatment
program.
Vantage Health Plan covers both brand name drugs and generic drugs. Generic
drugs have the same active-ingredient as a brand name drug. Generic drugs
usually cost less than brand name drugs and are rated by the Food and Drug Administration
(FDA) to be as safe and effective as brand name drugs.
If you are unable to locate your drug using the search, please contact Member Services
at 1-888-823-1910 (TTY 1-866-524-5144 for the hearing impaired) as your drug may
be covered as a generic drug under our plan.
Comprehensive Formularies
You can search the Vantage formulary to see if your drugs are covered according
to drug tier, quantity limit (QL) and if prior authorization (PA) from Vantage is
required before receiving the drug.
PA Criteria
Quantity Limits
Step Therapy
As a member of Vantage Medicare Advantage, you have the right to request a Coverage Determination, which includes the right to request
an expedited coverage determination, an exception, the right to file an appeal if
we deny coverage for a prescription drug, and the right to file a grievance.
- You can apply for Extra Help with Medicare prescription drug costs at http://www.socialsecurity.gov/prescriptionhelp.
- You can also contact your local Social Security office or call Social Security at
(800)772-1213 or for the hearing impaired, please call TTY (800)325-0778.
- The following link to the Vantage Medicare Advantage LIS table shows the amount
of Extra Help you can receive with Part D Prescription Drug cost & premiums
if you qualify.
2012 Low Income Subsidy (LIS) Premiums and Copays
Click Here for information about Transition
Fills and Medical Therapy Management Programs.
Click here for information about Formulary
Changes.
Members must use network pharmacies to access their prescription drug benefits except under non-routine circumstances. Prescription drug quantity limits and restrictions may apply.
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