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Is My Drug Covered?

Search 2012 Formulary Directory

Is My Pharmacy In-Network?

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Network?

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Formulary
(List of Covered Drugs)

Network PlatinumPlus Pharmacy, Network PlatinumPremier Pharmacy and Network PlatinumSelect Formulary

The Formulary provides coverage information about some of the drugs covered in our plans that have Part D prescription drug coverage. You may search, browse or use the alphabetical index to locate your drug. Network Health Insurance Corporation Pharmacy may add or remove drugs from our Formulary during the year. If we remove drugs from our Formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug.

All Part D plans from Network Health Insurance Corporation cover both brand name drugs and generic drugs, and include over 50,000 network pharmacies. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs." Brand-name drugs are capitalized (e.g., SINGULAIR) and generic drugs are listed in lower-case italics (e.g., warfarin).

The information in the "Requirements/Limits" column tells you if your plan has any special requirements for coverage of your drug.

Find Your Prescriptions

As we age, the likelihood - and often the amount - of prescription drugs we need increases. Enrolling in a health plan that includes valuable Medicare Prescription Drug coverage now will help you save money, providing the important "safety net" you need in the future. So even if you don't need prescription drugs now, you'll have the peace of mind knowing you have the right coverage when you need it most.

To obtain a tiering exception to the Plan’s drug formulary, download the Medicare Prescription Drug Coverage Determination Form that you can complete and take to your prescribing physician’s office.

Find your prescriptions in your plan.
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H5215_Website12 CMS Approved 12152011
Last Updated: 1/27/2012

Notice of Privacy Practices (2012)

Quality Initiatives (by clicking on this link, you will be leaving the Network Health Medicare-specific web pages)
Financial Information | Site Map | Network Health Plan (by clicking on this link, you will be leaving the Network Health Medicare-specific web pages)

Network PlatinumPlus, Network PlatinumPremier and Network PlatinumSelect are Medicare Preferred Organizations (PPO) plans offered by Network Health Insurance Corporation, a Medicare Advantage plan with a Medicare Contract. Benefits, formulary pharmacy network, premium and /or copayments and co-insurance may change on January 1, 2013.The Network Health Insurance Corporation Contract is renewed annually, so enrollment in a plan cannot be guaranteed.

We also offer NetworkCares PPO SNP, a $0 premium full dual eligible Special Needs Plan. NetworkCares is a Coordinated Care Plan with a Medicare Advantage contract and contract with the Wisconsin Medicaid Program. This plan is available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Part B premium unless otherwise paid for by Medicaid or by another third party. For information about this Special Needs Plan, please contact us at 1-800-983-7587 or 1-800-947-3529 Monday through Friday 8 a.m. - 8 p.m. From Oct. 15th through Feb. 14th we are available 8 a.m. - 8 p.m., 7 days a week. For the hearing impaired, call TDD/TTY 1–800–947–3529.

Network Cares has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2013/2014. NCQA’s approval is based on a review of NetworkCares Model of Care and is an indicator of compliance with CMS requirements. NCQA’s approval is not an endorsement by CMS and/or NCQA of NetworkCares or the quality of services provided by NetworkCares. NetworkCares will still need to be approved each year by CMS in order to operate. If you have any questions regarding our approval by the NCQA, please contact us at 1-800-378-5234.

You may be eligible for extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday. TTY users should all 1-800-325-0778; or
  • Your State Medicaid Office.

The benefit information provided here is a brief summary, not a comprehensive description of benefits. For more information, please contact the plan.

Network Health Insurance Corporation (NHIC) contracts with a network of providers within the 14 county service area to provide Medicare-covered benefits. Our Network Medicare Advantage plans are open to Medicare beneficiaries eligible by age or disability in the plan’s service area. Our Network Medicare Platinum Plans provide reimbursement for all covered benefits regardless of whether they were received in-network, as long as they are medically necessary. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.

Individuals must have both Medicare Part A and Part B to enroll and continue to pay their Part B premiums, unless otherwise paid for by Medicaid or by another third party. Plan benefit maximum limitations, copayments and restrictions may apply. To qualify, you must be a resident of the service area and not have End Stage Renal Disease (ESRD).

Members may enroll only during certain times of the year. If you enroll in one of our Medicare Advantage Pharmacy plans, you must receive your Medicare prescription drug benefit through the plan. Eligible members must use network pharmacies to access their prescription drug benefit except under non-routine circumstances; quantity limitations and restrictions may apply. Our Network Medicare Advantage Pharmacy plans use a formulary, which is a list of preferred drugs covered by the plan.

A partnership of Ministry Health Care and Wheaton Franciscan Healthcare.