Optimum Healthcare
 
Optimum HealthCare Inc.is a health plan with a Medicare contract
 

2010 Pharmacy Part D Coverage Information

Pharmacy Network Information
To search for a pharmacy, click on the Pharmacy Network Listing link below. Type your county or pharmacy name in the “FIND” box then click on the “FIND NEXT” button. 2010 Formulary Information (List Of Covered Drugs)
A formulary is a list of drugs covered by your plan to meet patient needs. To search for a drug, select the plan below. Once the document is opened, type your drug name or drug category in the “FIND” box then click on the “FIND NEXT” button.

2010 Formulary


Formulary Changes
Formulary list may change during the year. Updates, if any, will be posted monthly.
April 2010
July 2010
Sept 2010

Prior Authorization Criteria
Click here to learn which drugs require Prior Authorization.
Click here to find the Provider Exception Request form.

Step Therapy Criteria
Click here to learn which drugs must meet Step Therapy Criteria.

Drugs with Quantity Limits
Click here to find out about drugs with Quantity Limits.

Transition Policy
What can you do if your drug is not on the Drug List? Click here

CMS Best Available Evidence
Learn what can you do if you believe you are eligible for Low Income Subsidy but do not have a required piece of evidence.

Low Income Subsidy (LIS) Information
Learn how you may be able to get extra help

Grievance & Appeals
Click here to make a complaint or request an appeal about a Part D drug.

Drug Utilization Management & Quality Assurance
What to do if you have a problem or complaint about getting a part d drug?
Click here to learn more about how to ask for an Exception, a Coverage Determination an Appeal or to make a complaint.
 
Optimum HealthCare is a health Plan with a Medicare contract. Medicare approved MAPD HMO plans available to anyone entitled to Part A and enrolled in Part B of Medicare through age or disability (for MA plans, individuals must have both Part A and Part B). Medicare approved HMO Special Needs Plans (SNPs) available to anyone who meets the specific eligibility requirements of the SNP and is enrolled in both Part A and Part B of Medicare through age or disability. To qualify for a Dual Eligible SNP (DSNP), you must also be eligible for Medicaid assistance from the State. Premium for the DSP and copayments/co-insurance for Low Income Subsidy eligible beneficiaries may vary based on income. Enrollment period restrictions apply. Call the plan for details. You must continue to pay your Medicare applicable premiums if not otherwise paid for under Medicaid or by another third-party. Plans may be renewed annually. All plan types may not be available in all areas. Copayment and authorization rules may apply
H5594_OPT_Web_CMS_Dec09-02/10/2010                                                                                            Last Updated 06/14/2010
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Local Concierge Office
8373 Northcliffe Blvd,
Springhill, FL 34606
Corporate Headquarters
5403 N. Church Ave
Tampa, FL 33614
Optimum Healthcare