Peoples Health Group Medicare (HMO-POS)

30-Day Supply: $50 at a retail pharmacy

90-Day Supply: $100 at a retail or mail-order pharmacy with preferred cost-sharing, $150 at a retail or mail-order pharmacy with standard cost-sharing

The plan requires you or your doctor to get prior approval for this drug. This means the plan needs more information from your doctor to make sure the drug is being used and covered correctly by Medicare for your medical condition. Certain drugs may be covered by either Medicare Part B (doctor and outpatient health care) or Medicare Part D (prescription drugs) depending on how it is used. If you don’t get prior approval, the plan may not cover the drug.

Depending on how this drug is used, it may be covered by either Medicare Part B (doctor and outpatient health care) or Medicare Part D (prescription drugs). Your doctor may need to provide the plan with more information about how this drug will be used to make sure it’s correctly covered by Medicare.

The costs listed above apply if the drug is covered by Medicare Part D; if the drug is covered by Medicare Part B, the costs may vary. Contact Peoples Health for more information.

If you receive Extra Help from Medicare to pay for your prescription drug costs, your costs will be different. You will pay one of the following costs, depending on your level of Extra Help.

Level 1: $9.85     Level 2: $4.00     Level 3: $0     Level 4: 15% coinsurance

Extra Help is available for people with limited income and resources. Click here for more information about extra help.

Click here to view other drugs in this therapeutic category.

This drug is covered in the coverage gap for Peoples Health Group Medicare (HMO-POS), Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits, Peoples Health Secure Health (HMO D-SNP), Peoples Health Secure Choice (HMO D-SNP), and Peoples Hlth Secure Complete (HMO D-SNP) plan members. Please see your plan’s Evidence of Coverage for more information.