D  If you have questions, please call IEHP DualChoice at 1-877-273-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Drugs in each tier have a different cost. Page1of2 New 08/13 Form 61‐211 PRESCRIPTION DRUG PRIOR AUTHORIZATION REQUEST FORM Plan/Medical Group Name: Inland Empire Health Plan Plan/Medical Group Phone# :( 888) 860-1297 Plan/Medical Group Fax# :(909) 890-2058 Instructions: Please fill out all applicable sections on both pages completely and legibly. T  Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. The exception is the $0 Deductible Plans. All cost-sharing assumes in-network healthcare providers.Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit, Physicians that accept IEHP DualChoice (Medicare-Medicaid ) for California. IEHP DualChoice is a Cal MediConnect Plan. K  HealthPocket is a free information source designed to help consumers find medical coverage. Y  Drug Days Pricing: Review the 2015 Initial Coverage Formulary for IEHP Medicare DualChoice (HMO SNP) H5640-001 by Iehp Health Access Drugs starting with |P| & 30 days coverage. Copays for prescription drugs are $6.60 or less. ©1997-2021 Managed Markets Insight and Technology, LLC. Source:CMS Formulary Data Oct. 2014 IEHP Medicare DualChoice (HMO SNP) will begin paying approximately 95% of your covered medication expenses. If you dont get approval, the plan may not cover the drug. But please check with the plan providers to verify all information. 1.Pre-Deductable: Before you reach the plans deductible of $320. To find out if a drug is on the Formulary or to get a copy of the IEHP Formulary mailed to you, call IEHP Member Services at 1-800-440 ... (IEHP) is a local, not-for-profit, public health plan. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. IEHP scored 88 out of 100 for overall health plan ratings, placing IEHP DualChoice among the top 5 MMP plans in the country with the third-highest score. X  A  30 Day Supply, As a Percent of the total drug cost or a flat rate. Molina Dual Options Cal MediConnect Plan Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Q  A drug in a lower tier will generally cost you less. Talk to your doctor first about changing your prescription to a drug on your plans formulary. Los usuarios de TTY deben llamar al … Created Date: (AKA "donut hole") Once you reach the coverage gap you will be required to pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The plans below offer Medicare Advantage coverage to California residents. This formulary document is subject to change and may vary depending on your . However some drugs do not require that the deductible is met before you receive coverage. The Initial Coverage Limit (ICL) for this plan is $2960. F  IEHP DualChoice has more than 22,000 Members. 90 Day Supply, (Mouse over for Tips) Medicare Advantage plans are an alternative way to get your Original Medicare. Days Supply : 30 Days Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. That means the plan will only cover the drug up to a designated quantity or amount. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contract with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. IEHP Medicare DualChoice Provider and Pharmacy Directory. All Rights Reserved. Siempre puede consultar la Lista de Medicamentos Cubiertos actualizada de IEHP DualChoice en www.iehp.org o llamando al 1-877-273-IEHP (4347), 8am-8pm (Hora del Pacífico), los 7 días de la semana, incluidos los días festivos. You can see if the deductible is required below in the "Does the Deductible Apply" column. Transcription . As a Percent of the total drug cost or a flat rate. As a Percent of the total drug cost or a flat rate. Once you and your plan provider have spent $2960 on covered drugs. IEHP Dual Choice. 4.Catastrophic: Anything over $4700 you will receive a significant increase in coverage. R  Some plans have a $0 Deductible. Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, plan ratings, accepted doctors and more. Always review the privacy and terms of use of the partner website. J  C  © 2021 Inland Empire Health Plan. I  Coverage criteria is subject to change. This guidebook has a list of Medicare and Medi-Cal resources ….. Organized as a Joint Powers Agency, Inland Empire Health Plan (IEHP) is a local, not-for-profit, public health plan. Cost Non Pref: Your Cost for the Prescription Drug at a Non-Prefered Pharmacy. Cost Prefered: Your Cost for the Drug at the Providers In Network Prefered Pharmacy. This is a list of drugs that members can get in IEHP DualChoice. This plan is available in CA. IEHP Logo February 22, 2012 Toby Douglas, Director California Department of Health Care Services Office of Medi-Cal Procurement MS Code 4200 P.O. Please contact, Maximum out-of-pocket enrollee responsibility (does not include prescription drugs), Diagnostic procedures/lab services/imaging, Wellness programs (e.g., fitness, nursing hotline), Prosthodontics, other oral/maxillofacial surgery, other services, Kaiser Permanente Senior Advantage Basic Kern (HMO), Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan), 2018 Brings Good News for Medicare Enrollees, More $0 Premiums for Medicare Advantage in 2016, Inpatient hospital - psychiatric:$0 copay. $0 copay. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. W  2020 medicaid list of covered drugs (formulary) spp54212 101020i q4 v4 formulary drug (h9712) mmp part d comprehensive version 20 effective 12 01 This means that you will pay the same amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel). Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC and National Insurance Markets, Inc IEHP's DualChoice Cal MediConnect Plan and Medicare DualChoice are open to people who have both Medicare Parts A and B and Medi-Cal and have certain medical conditions or have American Indian Medi-Cal. California Medicare Advantage Plans. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the Get 2018 Medicare Advantage information on IEHP DualChoice (Medicare-Medicaid Plan) from IEHP DualChoice. This is a Medicare-Medicaid plan, with prescription drug coverage, for people with both Medicare and Medicaid benefits (dual-eligible). Coverage Gap, Included: Highmark Blue Cross Blue Shield, Highmark Blue Shield and Highmark Blue Cross Blue Shield West Virginia. Formulary Guidance This page provides important information on prescription drug coverage policies under Medicare, the framework for CMS' review of Medicare prescription drug plan formularies, and instructions concerning formulary file uploads. Coverage level : Initial Coverage These plans cover 100 percent of most services without requiring copays. The max in 2015 is $320. IEHP Medi-Cal Member Services (800) 440-4347 (800) 718-4347 (TTY) IEHP DualChoice Member Services (877) 273-4347 (800) 718-4347 (TTY) IEHP 24-Hour Nurse Advice Line (for IEHP Members only) If you still cannot locate your drugs, your plan may not offer coverage. Version: 2.2.0.26 Coverage Level:Pre-deductible,Initial Coverage Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage. This plan is available in CA. You can get this information for free in other formats, such as large print, braille, or audio. 60 Day Supply, 2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $2960 Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. download Report . B  The call is fr 2021 Medicare 2020 Medicare Drug Cost You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link on the left above the chart. Below is the Formulary, or drug list, for IEHP Medicare DualChoice (HMO SNP) from Iehp Health Access This formulary is a list of prescription medications that are covered under Iehp Health Access's UnitedHealthcare's home for Care Provider information with 24/7 access to Link self-service tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims and prior authorizations. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once completed, fax to 1 (877) 974-4411 or 1 (616) 942-8206. You can see if this plan offers coverage in the "donut hole" be clicking the "Coverage Gap" link on the left above the chart. Below is the Formulary, or drug list, for IEHP Medicare DualChoice (HMO SNP) from Iehp Health Access This formulary is a list of prescription medications that are covered under Iehp Health Access's 2015 Medicare Advantage Plan.The IEHP Medicare DualChoice (HMO SNP) plan has a $320 drug deductible. health plan. Plain text explanation available for any plan in any state. Z  A Cal MediConnect Plan is an organization made up of Doctors, Hospitals, Pharmacies, Providers of long-term services and supports, Behavioral Health Providers, and other Providers. M  Usually just an additional form. has no additional premium costs outside of your Medicare Part B premium, was the 5th best selling plan in Los Angeles in 2021. O  Click the selection that … We serve almost 1.25 million residents of Riverside and San Bernardino counties through government-sponsored programs including Medi-Cal (families, adults, seniors and people with disabilities) and Cal MediConnect. A formulary is a list of covered drugs selected by our plan 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. In 2015 if you have spent $4700 in expenditures you enter the Catastrophic Phase. HealthPocket.com provides information on insurance products. Disclaimer | Contacts Copyright © 2021 Medicare Help, State Health Insurance Assistance Programs SHIP, Click Here to see Ratings, Part C Premium, LIS, SNP and Coverage Area for IEHP Medicare DualChoice (HMO SNP), Sulfacetamide Sodium And Prednisolone Sodium Phosp, 50 Packet In 1 Carton > 10 Ml In 1 Packet, 1 Kit In 1 Kit * 2.5 Ml In 1 Syringe * .75 Ml In 1 Packet * 5 Ml In 1 Vial, Single-use, 10 Blister Pack In 1 Carton > 10 Tablet In 1 Blister Pack, 1 Bottle In 1 Carton > 60 Ml In 1 Bottle, 90 Tablet, Film Coated In 1 Bottle, Plastic, 1 Vial, Single-use In 1 Carton > 5 Ml In 1 Vial, Single-use, 9 Bottle, Plastic In 1 Case > 1500 Ml In 1 Bottle, Plastic, 1 Bottle In 1 Carton > 250 G In 1 Bottle, 1 Bottle In 1 Carton > 150 Ml In 1 Bottle, 1 Vial, Single-dose In 1 Carton > 2 Ml In 1 Vial, Single-dose, 1 Kit In 1 Carton * 30.6 Ml In 1 Vial * 30.6 Ml In 1 Vial, 1 Pouch In 1 Carton > 1 Syringe In 1 Pouch > .2 Ml In 1 Syringe, 1 Pouch In 1 Carton > 1 Syringe In 1 Pouch > .3 Ml In 1 Syringe, 1 Pouch In 1 Carton > 1 Syringe In 1 Pouch > .5 Ml In 1 Syringe, 1 Kit In 1 Package * 1 Ml In 1 Vial, Single-dose, 9 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack, 100 Tablet, Film Coated In 1 Bottle, Plastic, 6 Pouch In 1 Carton > 1 Blister Pack In 1 Pouch > 1 Kit In 1 Blister Pack, 1 Bottle In 1 Carton > 60 Tablet In 1 Bottle, 1 Bottle In 1 Carton > 30 Tablet In 1 Bottle, 6 Blister Pack In 1 Carton > 1 Kit In 1 Blister Pack, 1 Bottle, Spray In 1 Carton > 2.5 Ml In 1 Bottle, Spray, 30 Tablet, Film Coated In 1 Bottle, Plastic, 1 Bottle, Dropper In 1 Carton > 15 Ml In 1 Bottle, Dropper, 300 Tablet, Delayed Release In 1 Bottle, Plastic, 1 Blister Pack In 1 Carton > 9 Tablet In 1 Blister Pack, 2 Syringe In 1 Package > .5 Ml In 1 Syringe, 9 Blister Pack In 1 Carton > 9 Tablet In 1 Blister Pack, 1 Vial, Single-dose In 1 Carton > .5 Ml In 1 Vial, Single-dose, 1 Blister Pack In 1 Carton > 10 Tablet, Chewable In 1 Blister Pack, 1 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack, 1 Vial, Single-use In 1 Carton > 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Single-use, 2 Cartridge In 1 Carton > 1.5 Ml In 1 Cartridge, 1 Bottle, Spray In 1 Carton > 8 Ml In 1 Bottle, Spray, 1 Vial, Single-use In 1 Carton > 1 Ml In 1 Vial, Single-use, 1 Bottle In 1 Carton > 100 Capsule In 1 Bottle. Source:NDC Directory by FDA.gov Catastrophic L  Premium: A monthly flat fee that varies by plan. All Rights Reserved | Terms of Use We will generally cover the drugs listed in our formulary as long as the drug is Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, plan ratings, accepted doctors and more. IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. G  This form should be completed by the prescriber or healthcare professional in order to provide sufficient justification for the necessity of the non-formulary to treat their patient’s current diagnosis. TTY users should call 1-800-718-4347. IEHP DualChoice is a MMP Medicare Advantage plan, from Inland Empire Health Plan (IEHP), that's available to Medicare beneficiaries living in Riverside County, California. There may be limits on how much the plan will provide. Get 2019 Medicare Advantage information on IEHP DualChoice (Medicare-Medicaid Plan) from IEHP DualChoice. IEHP Medicare DualChoice (HMO SNP) (H5640-001) by IEHP Medicare DualChoice - Riverside County, CA. PHC with direction from the Pharmacy & Therapeutics (P&T) Committee and Physician Advisory Committee (PAC) has developed formularies for its line of business to be used by our clinicians and pharmacists for PHC members. **We make every attempt to keep our information accurate. 2015 Medicare Advantage Plan. 1-877-273-IEHP …. She wants to update to a more stylish frame this year and knows that her vision plan gives her an annual frame allowance, as … H  (combined amount plus your deductible) You will enter the coverage gap. This prescription drug formulary was updated on 12/04/2018 and is effective as of January 1, 2019. V  Cecilia, 27, is single and living in Miami, FL. 2021 Medicare Advantage Plan Benefits explained in plain text. Some plans offer select Pre-deductible drug Coverage IEHP DualChoice is a MMP Medicare Advantage plan, from Inland Empire Health Plan (IEHP), that's available to Medicare beneficiaries living in San Bernardino County, California. Box 997413 Sacramento, CA 95899-7413 Re: Dual Eligible Demonstration Project Dear Mr. Douglas: Inland Empire Health Plan (IEHP) is a not-for-profit, public health plan, serving 3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $4700 in 2015. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. The plan offers national in-network prescription coverage. Drugs Starting With Letter: S, Drugs Starting Letter: The IEHP Medicare DualChoice (HMO SNP) plan has a $320 drug deductible. Please check the formulary for different brand and generic names. Your enrollment date will depend on several factors, including which county you live in and whether you are already in a Medi-Cal managed care plan. What is Iehp dual choice? File a Medicare appeal, including for prescription drugs. E  Try changing the search distance or zip code. During the Catastrophic Period you will begin to receive significant coverage. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances. Comments . U  If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug. Most plans have 4 levels of coverage. You can also call Health Care Options to enroll in a plan at 1-800-430-4263 or TTY: 1-800-430-7077. N  The PHC 2021 Formulary. Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. BCIMAF: HIV / AIDS Lifesense N/A: 086 080 6080 Bestmed Medical Scheme: BEAT 1: Chronic & PMB: Bestmed: Bestmed Basic: 086 000 2378 Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. The below form can be used for commercial, medicaid and MIChild insurance. The copy editor at a local magazine has worn prescription glasses since she was a young girl. No results found. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered. (Click the Drug Name to Compare every Plans Price). This is a Medicare-Medicaid plan, with prescription drug coverage, for people with both Medicare and Medicaid benefits (dual … HPMS Approved Formulary File Submission ID 00019572, Version 19. We do not have any data on plans available in your area. It also has care coordinators and care teams to help you manage all your providers and services. You will receive a choice form in your 60 day packet that you can use to select a plan. P  S  Personal Choice Sentara Optima Type 1 Type 2 CMN BG Logs Notes Lab Report A1C DX Download Diabetes Type Personal Use CGM Criteria * Highmark, Inc. IEHP DualChoice is a Cal MediConnect Plan. For more recent information or questions about which drug formulary applies

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