Formulary

FORMULARY

FORMULARY


For a list of drugs covered under your plan, view or download the comprehensive formulary below. A comprehensive formulary includes the entire list of drugs covered by MeridianComplete . This formulary is a list of covered drugs selected by MeridianComplete

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.

MeridianComplete

will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a

MeridianComplete

network pharmacy, and other plan rules are followed. 

 

 

For more information on how to fill your prescriptions, please review your Member Handbook.


Formulary Updates

The Formulary Updates document outlines drugs that have been updated, added to, or removed from our current formulary.

 

Generally, if you are taking a drug on our 2017 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2017 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.

  

Cost Sharing Information

MeridianComplete has no premiums, deductibles, or coinsurance. You may pay a small copay for prescriptions covered by MeridianComplete. The amount of your prescription copay varies based on the level of Extra Help you receive, and whether the prescription is covered by Medicare or Medicaid.

2017 Copays

In 2017 for generic drugs covered by Medicare (including brand drugs treated as generic) you will pay either a $0 copay, a $1.20 copay, or a $3.30 copay. In 2017, for brand drugs covered by Medicare, you will pay either a $0 copay, a $3.70 copay, or a $8.25 copay. 

 

If you have any questions or concerns about premiums and/or cost-sharing associated with enrollment in MeridianComplete, or you receive a bill for medical or prescription services, please call Member Services at

1-855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

 

 

How to Request an Exception to the Formulary 

Click here to learn about Medicare Part D coverage determination requests and Part D redetermination requests. The request forms are also located on this page. 

To obtain the most complete and up-to-date information, or to obtain a list of alternatives to a drug we do not cover please contact MeridianComplete Member Services at

1-855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

MEDICARE DISCLAIMER

MeridianComplete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.

 

You can get this document in Spanish, or speak with someone about this information in other languages for free. Call

1-855-580-1689 (TTY users should call 711)

,

Monday - Sunday, 8 a.m. to 8 p.m.

  The call is free.

 

Usted puede obtener gratuitamente este documento en español o hablar con alguien sobre esta información en otros idiomas. Llame al

1-855-580-1689

(los usuarios de TTY deben llamar al 711), lunes a domingo, de 8 a.m. a 8 p.m. La llamada es gratuita.

 

Limitations, copays, and restrictions may apply. For more information, call MeridianComplete Member Services or read the MeridianComplete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.

 

For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at

1-855-580-1689 (TTY users should call 711)

.

Page Last Modified: 11/20/2017 2:43:27 PM