Formulary
Formulary, a list of covered drugs
Samaritan Advantage Health Plan HMO formulary contains a list of drugs, selected 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. Samaritan Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Samaritan Advantage Health Plan network pharmacy and other plan rules are followed.
See
Member Resources for the
Formulary (List of Covered Drugs)
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 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.
In general, beneficiaries must use
network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply.
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: October 1, 2011
H3811_MA4003_2012 CMS Approved 10/14/2011