Harvard Pilgrim’s Pharmacy & Therapeutics (P&T) Committee is an advisory group comprised of Harvard Pilgrim clinical staff, as well as physician specialists, independent physicians, and pharmacy specialists who work together to promote clinically sound, cost-effective pharmaceutical care. Please bear with us as we work to upgrade this information to the same standards as the rest of our website. Need help with your account? Tier 2 Preferred brand drugs 30% up to $50/script Tier 3 Non-preferred brand drugs 40% up to $250/script Tier 4 Specialty drugs 50% up to $750/script **For HSA plans, deductible must be met first, excluding certain preventive drugs. Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. Harvard Pilgrim offers PPO plans. This guide provides a detailed explanation of the Medicare Part D drug coverage stages, what the "donut hole" is and how it factors into your out-of-pocket costs. Core NH 4-Tier Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. Formulary lookup and preventive drug lists for Premium, Core NH, and Value formularies. Harvard Pilgrim Health Care HSA $5,000/50% ACA Metal: Bronze All plans are open access and contract year. Harvard Pilgrim Health Care and Tufts Health Plan Have Combined; Harvard Pilgrim Health Care-Tufts Health Plan Combination Finalized; Pharmacy Resources. Call (888) 333-4742 (TTY: 711). 2021 Prescription Drug Plans: Value 3-Tier Value 4-Tier Value 5-Tier Premium 3-Tier Premium 4-Tier Core NH 4-Tier Core NH 5-Tier * Not all employer-sponsored plans offer Harvard Pilgrim prescription drug benefits. 2019 Harvard Pilgrim Stride Value Rx Plus (HMO) Formulary. Every drug in the formulary (drug list) has a tier number. This formulary is a list of prescription medications that are covered under Harvard Pilgrim Health Care Inc.'s Medicare Advantage Plan in Massachusetts. Southern Scripts a unique PBM model with three core components. Read more Prescription Drug … Premium 3-Tier ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. SilverScript Medicare Part D formulary tiers indicate the level of cost-sharing for a covered drug. Contact Member Services at (888) 333-4742. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1Group LLC *For HSA plans, deductible must be met first, excluding certain preventive drugs. Harvard Pilgrim is a leading not-for-profit health services company serving members in Connecticut, Maine, Massachusetts, New Hampshire and beyond. Harvard Pilgrim Health Care POS $35/$50–$4,000/50% ACA Metal: Silver All plans are open access and contract year Harvard Pilgrim offers PPO plans. The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. Register now! Call (888) 333-4742 (TTY: 711). Tufts Health Plan Medicare Preferred uses Formularies to list the prescription drugs that each of our different plan types cover. If you need drugs to treat your illness or condition More information about prescription drug coverage is ... Non-preferred brand drugs (Tier 3) Retail: 20% Coinsurance Mail Order: 20% . ©2021 Harvard Pilgrim Health Care, Inc. All rights reserved. Y0098_21113_M Accepted                          Last Update Date – 10/01/2020. Harvard Pilgrim Health Care StrideSM Basic Rx (HMO), StrideSM Value Rx (HMO), StrideSM Value Rx Plus (HMO), StrideSM Choice Rx (HMO-POS) and StrideSM Gain RxSM (HMO) 2020 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary File ID#20231, Version Number You’ll find the tier number listed next to each drug. If member purchases a brand drug The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. Our exceptional clinical quality and member satisfaction rate us consistently among the top plans in the co The number of dollar or percentage amounts next to "Rx" on your card will tell you how many tiers your plan has. You can use the search tools below to find out if your drugs are covered and which tier they fall under on your plan type. Below is the Formulary, or drug list, for Harvard Pilgrim Stride Value Rx Plus (HMO) from Harvard Pilgrim Health Care Inc. Skip to content Skip to footer Harvard Pilgrim Health Care Close Menu Close Search Website Member? This formulary is a list of prescription medications that are covered under Harvard Pilgrim Health Care … A formulary is a list of prescription medications that are covered under Harvard Pilgrim Health Care Inc.'s 2020 Medicare Advantage Plan in Massachusetts. Mail Order Prescriptions Mail order drugs are dispensed at 2x the retail prescription co-pay or cost share. Our goal is to provide employers with the right tools to achieve optimal health outcomes for their members by providing ideal access for prescription medications. Harvard Pilgrim Health Care POS $30/$50–$3,000/25% ACA Metal: Gold All plans are open access and contract year Harvard Pilgrim offers PPO plans. Harvard Pilgrim Stride Value Rx (HMO) H6750-002 is a 2019 Medicare Advantage or Medicare Part-C plan by Harvard Pilgrim Health Care of New England, Inc. available to residents in New Hampshire. MaineCare Preferred Diabetic Supply List- Effective January 1, 2021 200.76 KB 2020/12/31 MaineCare Preferred Diabetic Supply List- Effective July 1, 2020 171.08 KB Harvard Pilgrim Health Care POS $30/$45–$1,800 ACA Metal: Gold All plans are open access and contract year Harvard Pilgrim offers PPO plans. Click a plan to look up drugs, get prices, find in-network pharmacies and more. Your 2021 Premium Standard Formulary Effective January 1, 2021. If your card has dollar or percentage amounts next to "Rx" but does not say "Premium" or "Value", you have a Premium plan. The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. Value 5-Tier * Not all employer-sponsored plans offer Harvard Pilgrim prescription drug benefits. 2019 Harvard Pilgrim Stride Basic Rx (HMO) Formulary Below is the Formulary, or drug list, for Harvard Pilgrim Stride Basic Rx (HMO) from Harvard Pilgrim Health Care Of New England, Inc. If member purchases a brand drug If member purchases a brand drug Coinsurance: A Prescription Drug List (PDL) – also called a formulary – is a list of commonly used medications, organized into cost levels, called tiers. Monday - Friday 8 a.m.–8 p.m. 1–800–890–6600 (TTY: 711) You may ask us to provide a higher level of coverage for your drug. If you do not see the druglist you need, please visit Prescription Drug Lists and Coverage Please bear with us as we work to upgrade this information to the same standards as the rest of our website. In general, the lower the tier, the lower your cost for the drug. Value 3-Tier The type of drug plan you have (either Premium, Value or Core NH) will be shown on your ID card. The information you are about to access may not meet accessibility standards for people with disabilities, including visual impairment, nor is it optimized for people using tablets or phones. Plus, if the retail amount for a drug is lower than your copayment, you pay the lower amount. 2019 Harvard Pilgrim Stride Value Rx Plus (HMO) Formulary Below is the Formulary, or drug list, for Harvard Pilgrim Stride Value Rx Plus (HMO) from Harvard Pilgrim Health Care Of New England, Inc. Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, hospital services, accepted doctors and more. If your drug is contained in our non-preferred tier (Tier 3), you may ask us to cover it at the cost-sharing amount that applies to drugs in the preferred tier (Tier 2) subject to the tiering exceptions process. Tier 2 Preferred brand drugs 30% up to $50/script Tier 3 Non-preferred brand drugs 40% up to $250/script Tier 4 Specialty drugs 50% up to $750/script **For HSA plans, deductible must be met first, excluding certain preventive drugs. A deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019 – 12/31/2019 Harvard University Medical Plan: Harvard Pilgrim Health Care (HPHC) HDHP Coverage for: Individual and Family Plan Type: PPO CovCover Coverage for: _____ | Plan Type: _____ 1 of 6 SBC #8 HPHC HDHP (Nonunion) 2019 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. 2020 Newsletter Archive; Newsletter Archives (2019, 2018 – prior to March 2018) The Coding Corner. 2019 Harvard Pilgrim Stride Basic Rx (HMO) Formulary. SilverScript plans use a system with five Medicare formulary tiers. The example shown is a Value 5-Tier plan. Call us toll free. Please contact Member Services or your Human Resources department to find out more about your coverage. This plan includes additional Medicare prescription drug (Part-D) coverage. Create a secure account to see your personal health information.. Forgot password or username? Core NH 5-Tier. To view the 2021 Cigna drug list: Choose a drug list from the drop down menu below to view medications that are commonly covered. For the most current list of covered medications or if you have questions: Call the number on your member ID card. Get Health Insurance plan info on ElevateHealth Silver 3500 from Harvard Pilgrim Health Care of NE. BILHPN Pharmacy Newsletter; Newsletter Archives. 2019 Harvard Pilgrim Stride Gain Rx (HMO) Formulary Below is the Formulary, or drug list, for Harvard Pilgrim Stride Gain Rx (HMO) from Harvard Pilgrim Health Care Of New England, Inc. Value 4-Tier Call us toll free. Prescription Drugs (retail) (MAC-A: mandatory generic) Generic substitution is required when available. These costs are decided by your employer or health plan. If member purchases a brand drug In general, the higher the tier, the higher the member’s out-of-pocket cost for the covered drug. Click a plan to look up drugs, get prices, find in-network pharmacies and more. ©2021 Harvard Pilgrim Health Care, Inc. All rights reserved. Cost-Sharing Tier 1: Preferred Generic Tier 1 is the lowest tier. Below is the Formulary, or drug list, for Harvard Pilgrim Stride Basic Rx (HMO) from Harvard Pilgrim Health Care Inc. The tier number determines the general cost of the drug. Premium 4-Tier ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Monday - Friday 8 a.m.–8 p.m. 1–800–890–6600 (TTY: 711) The Harvard Pilgrim Stride Value Rx (HMO) plan has a $350 drug deductible. A unique PBM model with three Core components Medicare prescription drug coverage, services... Retail prescription co-pay or cost share ) plan has you free of charge out more about plan monthly cost premimum! 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