This tool allows you to search Medica's Medicare formularies to determine whether your drugs are covered and at what level they are covered. Each Medicare formulary includes three coverage levels in which the amounts you pay for prescriptions differ as your prescription drug totals add up throughout each benefit year.
Medica Complete Solution Prescription Drug Coverage
A 4 Tier Open Formulary that includes Part D Drugs wraps in Benefit Set ($10, $34, $67, 25% Specialty)
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Level 1: Initial Coverage Level
You pay a copay or a fixed dollar amount for your prescription drugs. Copays on generic drugs are $10, preferred brand drugs are $34 and brand non-preferred drugs are $67. These will your copay amounts until the shared total amount paid by you and Medica for your prescription drugs reaches $2700 for the benefit year.
Level 2: Gap Coverage Level
You pay 100% of costs for all your prescription drugs until your total out of pocket expenses (the total amount you paid in Level 1 + the total amount you paid in Level 2) reach $4350 for the benefit year.
Level 3: Catastrophic Coverage Level
You pay the greater amount of $2.40 for generic (including brand drugs treated as generic) and $6 for all other drugs or 5% coinsurance for the remainder of the benefit year.
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For assistance with your pharmacy benefit, please contact Medica customer service from 8 a.m. - 8 p.m. CST, seven days a week.
Please note that access to a representative may be limited on weekends and holidays during certain times of the year.952-992-2345 or 1-800-906-5432
TTY: 952-992-3650 or 1-800-234-8819
E-mail:
centerforhealthyaging@medica.com.
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