You can search your comprehensive
formulary by entering the first few letters of the
drug name. The search will return the specific drug
name, what tier the drug belongs to, whether or not the drug
requires prior authorization (Prior Auth), any quantity limits and
whether or not any prior step therapy (Step) is required. If no records are
returned, the drug is not covered or you may have misspelled
the drug name. This information does not apply to the
special needs plan for dual eligibles, Value One Florida.
Cost sharing for this plan is dependent upon your Medicaid
eligibility level. Call customer service at
1-866-747-2700 for more information.
Select your type of plan:
Enter the first few letters of the
drug's name to find your drug.
Click on the blue drug name to find your
co-pay. In the pop-up window,
select the tier of your drug displayed
in Step 2 and your plan name.
If you would like to see if there is a
less expensive alternate in the
Formulary, click on the blue
"More" in the same row as your drug.
IMPORTANT: Please note that
after your yearly out-of-pocket
drug costs reach $4050, you pay the greater of:
$2.25 co-pay for generic (including brand name
drugs treated as generic) and $5.60 co-pay for
all other drugs, or
5% coinsurance.
This is called Catastrophic Coverage. The
threshold for this level of coverage is the sum of all your
expenditures for Medicare covered drugs including any
deductibles, co-pays and gap coverage payments. This is called your
True Out of Pocket Expenses, TrOOP. You may find out
your TrOOP expenses on a daily basis by calling toll free:
