Part D benefits are included with our Silver Plus, Platinum & Platinum Plus plans.
With Senior Health Plan (HMO), getting your prescriptions is simple. Our plans have no deductibles to meet, and no “preferred” pharmacy network to worry about.
Below are the member copays while in the Initial Coverage Limit:
| 30 Day Supply | Silver Plus | Platinum & Platinum Plus |
|---|---|---|
| Tier 1 - Preferred Generic | $5 | $0 |
| Tier 2 - Generic | $10 | $5 |
| Tier 3 - Preferred Brand | $40 | $40 |
| Tier 4 - Non-Preferred Brand | $95 | $95 |
| Tier 5 - Specialty Tier | 33% of the cost | 33% of the cost |
| Select Insulins | $35 copay for covered insulins | $35 copay for covered insulins |
For 2022, this plan participates in the Part D Senior Savings Model which offers lower, stable and creditable out of pocket costs for covered insulin through the different Part D benefit coverage stages. You will pay a maximum of $35 for a 1-month supply of select insulins during the Initial Coverage and Coverage Gap (or Donut Hole) stages of your benefit
Search for prescription medications that promote clinically useful and cost-effective drug therapy. You can look up your prescriptions in our online formulary to see what tier level your prescriptions are in.
CommunityCare members can save money on a 90 day supply of your prescription drugs when you use mail order.
| 90 Day Supply - Mail Order | Silver Plus | Platinum & Platinum Plus |
|---|---|---|
| Tier 1 - Preferred Generic | You pay $5 | You pay $0 |
| Tier 2 - Generic | You pay $10 | You pay $5 |
| Tier 3 - Preferred Brand Name | You pay $80 | You pay $80 |
| Tier 4 - Non-Preferred Drugs | You pay $190 | You pay $190 |
| Tier 5 - Specialty Tier | You pay 33% of the cost | You pay 33% of the cost |
Choose from two convenient options. More mail order prescription information.
Senior Health Plan is pleased to make its pharmacy directory available to its members. The online directory is for your reference only.
Senior Health Plan makes every effort to maintain current and accurate pharmacy data; however, periodic changes to a pharmacy's status can occur. Please contact Customer Service at (918) 594-5323 or 1-800-642-8065 if you have questions about a pharmacy's participation with Senior Health Plan. TTY/TDD users should call 1-800-722-0353.
The participating pharmacies listed in the directory are independent contractors and are not employees of Senior Health Plan. All health care decisions are strictly the responsibility of the patient and the pharmacy.
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan. Low income subsidy premium table
For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. More information regarding our drug management programs.
CMS has created a best available evidence (BAE) policy, which requires sponsors whose plans cover Part D prescription drugs to provide access to those drugs at the correct low-income subsidy (LIS) cost-sharing level when presented with evidence of a beneficiary's LIS eligibility, even if the sponsor’s system and CMS’s system do not yet reflect that eligibility. Best Available Policy and related resources located on the CMS website.