Medicare Advantage
Prescription Drug Information
SunSaver (HMO) plan
What is a Formulary?
A formulary is a comprehensive list of covered drugs selected by a team of health care providers as a part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. Formulary documents may be updated monthly.
Can the Formulary change?
Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the current coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
Formulary
Our comprehensive formulary is available in two formats
2022
PDF - Updated December 1, 2022 & Online Search
Formulary Annual Notice of Change
Formulary Monthly Notice of Change - Updated on July 1
Prior Authorization (Coming Soon) and Step Therapy Criteria (Coming Soon)
2021
Formulary Annual Notice of Change
Formulary Monthly Notice of Change
Prior Authorization and Step Therapy Criteria
Participating pharmacies
Pharmacies — listed in the provider/pharmacy directory
Mail order pharmacies
- Health First Family Pharmacy
- HealthWarehouse.com — you must use HealthWarehouse.com if you need your drugs shipped outside of Florida.
Please see your Evidence of Coverage for the following information:
- How to get prescription drugs shipped to your home
- The amount of time it will take to receive your drugs
- If your mail order is not received within the estimated timeframe, please contact our Care Team.
Forms
Requirements
- Process for Part D prescription drug prior authorizations, exceptions, appeals and grievances
- Transition policy
- Medication Therapy Management
- Drug and/or Utilization Management
Extra help for prescription drug costs
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
- The Social Security Administration at 1-800-772-1213 between 7am and 7pm, Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
- Your local Social Security office.
- Your State Medicaid Office.
Assistance with Best Available Evidence for Low Income Subsidy
AdventHealth Advantage Plans is administered by Health First Health Plans. Health First Health Plans is an HMO plan with a Medicare Contract. Enrollment in Health First Health Plans depends on contract renewal.
Y0089_EL9652AH_M | Accepted date: 10/01/2021
Last updated: 05/31/2022