Are my drugs covered?

Are my drugs covered?

Samaritan Advantage Premier, Premier Plus, and Special Needs Plan HMOs use a formulary. A formulary is a list of drugs covered by your plan to meet patient needs.

Samaritan Advantage Premier Plan, Premier Plan Plus, and Special Needs Plan cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula 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.

2013 Formularies (list of covered drugs)
The formularies may change throughout the year. See INSTRUCTIONS BELOW on how to search the formularies for a specific medication. These formularies do not contain the names of all medications available in the market. If your medication is not listed, please contact Samaritan Advantage Customer Service for assistance.

Premier Plan and Special Needs Plan (PDF)
Updated 10/2013 CMS Approved, FID: 00013305 Version: 28

Premier Plan Plus (PDF)
Updated 10/2013 CMS Approved, FID: 00013305 Version: 28

2013 Formulary Changes (PDF)
Updated 10/2013 CMS Approved, FID: 00013305 Version: 28

2013 Formulary Prior Authorization requirements (PDF)
2013 Formulary Quantity Limits (PDF)
2013 Formulary Step Therapy Criteria (PDF)

If you are currently taking a drug that is not on our formulary or subject to additional requirements or limits, you may be able to get a temporary supply of the drug. You can contact Samaritan Advantage Customer Service to obtain more information on how to request an exception or switch to an alternative drug listed on our formulary with your physician's help.

ADOBE READER SEARCH TIPS for your 2013 Formulary (List of Drugs)
Once you have opened the link to the Formulary found above, you can search the document for a specific prescription drug. Just hold down the Ctrl + f keys on your keyboard to use the "Find" function within Adobe Reader, then type in the name of the drug that you are seeking.

Network pharmacies
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply.

I M P O R T A N T   N O T I C E
A change in the law requires companies that make brand-name prescription drugs to give a discount on those drugs to Medicare. Beginning January 1, 2011, prescription drugs made and sold by companies that have not agreed to give a discount to Medicare can no longer be covered (paid for) by Medicare Prescription Drug Plans.

For additional help, visit the Medicare Prescription Drug Plan Finder. By clicking this link, you will be leaving the Samaritan Health Plan website:

Extra help with prescription drug costs

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid office.

Last modified: November 5, 2013
H3811_MA4001_2012I CMS Approved 12/13/2013