Prescription Drugs

 

Your Rx Drug Benefit for 2018
As a member of AlohaCare Advantage Plus (HMO SNP), you are automatically qualified for "Extra Help" to pay for your prescription drug costs. This is also called "Low Income Subsidy" or LIS.

 

Full Amount
With Extra Help from Medicare, depending upon your income and institutional status, you pay:
Deductible:
$0
Generic:
$0 or $1.25 or $3.35*
For all other drugs:
$0 or $3.70 or $8.35*


* All cost sharing is based on your level of Medicaid eligibility. Contact Medicaid for details.

The formulary is a list of the drugs that we cover. Generally, we will cover the drugs listed on our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other coverage rules are followed. We may add or remove drugs from our formulary during the year.

2018 Comprehensive Formulary (updated 08/2018)

A formulary is a list of covered drugs selected by AlohaCare Advantage 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.
H5969_400620_18  Approved