2024 Formulary.pdf

VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP), Medicare Health Advantage Plan (HMO D-SNP), Medicare Health Advantage FLEX Plan (HMO D-SNP), Medicare Select Advantage Plan (HMO)
Formulary changes: Most changes occur on January 1, but additions or removals of drugs, changes to cost-sharing tiers, or new restrictions may occur during the year
Notice of changes: Members will be notified at least 30 days prior to the effective date of change, or at the time of refill for affected members
Exceptions: Members or prescribers can request an exception to continue coverage of a brand-name drug if it is replaced by a generic or removed from the formulary
Vaccines: Most Part D vaccines are covered at no cost to the member
Insulin: Members will not pay more than $35 for a one-month supply of each insulin product covered by the plan
Pharmacy network: Members must use network pharmacies to access prescription drug benefits
* Contact information: VillageCareMAX Member Services (1-800-469-6292 or 711 for TTY users), Independent Consumer Advocacy Network (ICAN) (1-844-614-8800 or www.icannys.org)