Check Our Medicare Drug List

See if your prescription drug is covered

Our prescription drug list (formulary) shows:

The drugs we cover
The tier a drug is on
Drug requirements or limits
Mail order availability through Aetna Rx Home Delivery®

Generally, the lower the tier, the less you pay. Your Evidence of Coverage (EOC) tells you the drug costs for tiers.

Check drug coverage & costs

Guests - Select a plan & find your drugs

View drug-related documents for your plan

The following counties are in the Innovation Health Medicare service area: Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City, Fredericksburg City, Loudoun, Manassas City, Manassas Park City, Prince William, Spotsylvania, Stafford

Innovation Health Medicare Voyager Plan (PPO) - H1100-001

List of covered drugs (Formulary)

List of covered drugs (Formulary)-(Spanish)

Drug List Changes

Prior Authorization Information

Step Therapy Information

Innovation Health Medicare Connection Plan (HMO) - H2829-001

List of covered drugs (Formulary)

List of covered drugs (Formulary)-(Spanish)

Drug List Changes

Prior Authorization Information

Step Therapy Information

Other drug references

Changes to the drug list (formulary)

We update our covered drug list monthly. We may make changes based on findings from:

The Food and Drug Administration (FDA)
The Centers for Medicare & Medicaid Services (CMS)
Clinical standards of care

We don’t often discontinue or reduce drug coverage during the plan year. If we remove drugs from our list or add prior authorization, quantity limits or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify you. This must be at least 60 days before the change is effective. Or it may be when you request a refill of the drug. Then you’ll get a 60-day supply of the drug.

If the FDA views a drug on our formulary as unsafe or the drug maker removes the drug from the market, we’ll remove the drug from our formulary. We’ll send you a notice if you’re taking the drug.

Prior authorization, quantity limits & step therapy

Some covered drugs may have additional requirements or limits. These include:

Prior authorization
You or your doctor may need approval for certain drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
Quantity limits
For certain drugs, we limit the amount of the drug. We may limit coverage to 30 tablets for a 30-day supply. We may also limit fills to a one-month or three-month supply.
Step therapy
In some cases, we require you to first try certain drugs to treat your condition before we cover another drug for that condition. For example, if drug A and drug B both treat your condition, we may not cover drug B unless you try drug A first. If drug A doesn't work for you, we'll then cover drug B.

Look in the formulary for more requirements or limits.

If you’re a member, you can request an exception if your drug has a prior authorization, quantity limit, or step therapy requirement, or if the drug isn't covered on our formulary.

Transition rules

You may be on drugs that aren't on our drug list or covered with added requirements or limits.

Talk with your doctor

Your doctor can help you decide if you should switch to a covered drug or request a drug exception. It may help to share your formulary with your doctor. In the meantime, we may cover a temporary supply of your drug in certain cases during your first 90 days.

Transition supply

For any of your drugs not on our drug list or covered with additional requirements or limits, we'll cover up to a 30-day supply. This temporary supply should allow you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.

You must fill your prescription at a plan network pharmacy.

After your 30-day transition supply, we won't pay for these drugs unless you get approval for a drug exception. This is even if you're a plan member less than 90 days.

Learn more about our transition process

Details about our 2018 transition process

Transition of coverage enrollment letter

Transition of coverage enrollment letter (Spanish)

Long-term care facility residents: read this

You can refill your prescription until we've given you a transition supply (91-98-day supply). This may depend on drug maker packaging or if you have a prescription written for fewer days.

We’ll cover more than one refill of these drugs for the first 90 days you’re a plan member.
If you need a drug that’s not on our list or if your ability to get your medicine is limited, but you’re past the first 90 days of membership, we’ll cover up to a 31-day emergency supply of that drug.
If you’re discharged or move to a new long-term care facility, your doctor or pharmacy can request a one-time prescription override. This will give you up to a 30-day supply for that drug.

Participating physicians, hospitals and other health care providers are independent contractors. They're neither agents nor employees of Innovation Health. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change.

View of a senior woman holding medicines

We're here to help!

Members:
Email us or call Member Services at the number on your ID card.

Don’t have your ID card handy?
Find a phone number

Not yet a Member?
Email us or call an Innovation Health representative at 1-800-572-7124 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.

We speak your language: We have free interpreter services to answer questions you may have about our health or drug plan.
Get help from an interpreter

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Disclaimers

Innovation Health is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Innovation Health Medicare’s pharmacy network includes limited lower cost, preferred pharmacies in: rural Maine, rural Missouri and rural South Dakota. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-866-471-9374 (TTY: 711) or consult the online pharmacy directory at http://www.innovationhealthmedicare.com/pharmacyhelp.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.

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Members

See if your prescription drug is covered

Check drug coverage & costs

View drug-related documents for your plan

Innovation Health Medicare Voyager Plan (PPO) - H1100-001

Innovation Health Medicare Connection Plan (HMO) - H2829-001

Other drug references

Changes to the drug list (formulary)

Prior authorization, quantity limits & step therapy

Transition rules

Talk with your doctor

Transition supply

Learn more about our transition process

Long-term care facility residents: read this

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