We have many Medicare Part D resources available to help you understand the prescription drug coverage that comes with your HealthPartners Medicare plan. You’ll also find information about the Medicare Extra Help program, answers to frequently asked questions about our drug coverage and details about our transitional medication policy.
These plans use our Formulary I drug list. To see if your prescriptions are covered, you can use our online search tool or download a PDF of our drug list.
We have a drug list specifically for people enrolled in our HealthPartners MSHO plan.
Group retiree plans may use Formulary I or Formulary II. If you don’t know which one applies for you, please
HealthPartners Medicare plan members can choose from a network of more than 63,000 pharmacy locations.
If you have questions about your medications or how your Medicare Part D coverage works, we’re here to help.
Each Medicare prescription drug plan has its own list of covered drugs, known as a formulary.
Our pharmacists and doctors update the drug lists each year based on the latest medication and treatment information, which helps us include the safest and most effective prescription drugs available.
As you look through our drug list, you may notice that your plan places drugs into different tiers.
Drugs in each tier have a different cost. Knowing what tier your drug is in – together with looking at your plan’s benefits – can help you predict how much that drug will cost. Drugs in lower tiers generally cost less than drugs in higher tiers.
- Tier 1: Preferred generic drugs
- Tier 2: Generic drugs
- Tier 3: Preferred brand drugs and select insulin drugs
- Tier 4: Non-preferred drugs
- Tier 5: Specialty drugs
For those in an MSHO plan, your plan has only one tier. Your copay depends on whether the drug is generic or brand-name.
Both prescription medicine and over-the-counter medicine can have brand-name and generic versions. Brand-name and generic drugs use the same active ingredients, and they have the same dosage, strength, instructions and use. The Food and Drug Administration (FDA) requires generic drugs to be as effective as brand-name drugs.
The main differences between generic and brand-name drugs are their appearance and cost. Trademark laws require generic drugs to look different from brand-name versions. Generic drugs also usually cost less than the brand-name versions.
Specialty drugs tend to be high-cost drugs, often used to treat complex or rare conditions.
It depends. If your plan has a deductible, you’ll need to pay the full cost of each prescription that applies toward the deductible until the deductible is met. After that, HealthPartners will share the cost of your prescription drugs.
The amount you’ll pay is determined by the tier your drug is in and your plan’s benefits. Keep in mind that not all tiers may apply toward the deductible. That means your HealthPartners plan may share the cost immediately for some prescriptions.
If you qualify, Medicare could pay up to 100% of your drug costs through the
Finally, the amount you pay can depend on where you fill your prescriptions. The cost can be different at a network pharmacy, an out-of-network pharmacy or a
Sometimes, some covered drugs may have extra requirements or limits.
Certain drugs, even if they’re on the drug list, may require prior authorization. This means you’ll need to get approval from HealthPartners before you fill your prescription. If you don’t get prior approval, your drug may not be covered.
Some drugs have limits on the amount we’ll cover. For example, we may cover only a 30-day supply for refills of a particular drug. There may also be a limit on the quantity of a specific prescription that we’ll cover in one day.
In some situations, you may be required to try another drug before we cover the drug you’re requesting. For example, if Drug A and Drug B both treat your medical condition, HealthPartners may not cover Drug B until you try Drug A first. If Drug A doesn’t work for you, we would then cover Drug B.
Yes. With thousands of drugs on the market and new ones introduced each year, we continually evaluate and update our drug list. This way, we can make sure you have access to prescriptions that are high in quality, safe and cost-effective.
If we plan to remove drugs from the list or plan to add restrictions, we’ll let you know at least 60 days in advance. Also, there may be times when we immediately replace a brand-name drug on our list with a new generic drug. The new generic drug will appear on the same cost-sharing tier or lower, with the same restrictions or fewer. After the change is made, we’ll provide you with information about the specific change.
If the FDA deems a drug to be unsafe or if a manufacturer takes a drug off the market, we remove it from our drug list immediately. If this happens, we’ll let you know and work with you to find a replacement.
If you can’t find your drug on the list,
If we no longer cover your drug, start by talking with your doctor about other options from our drug list. If no alternatives are available, you or your prescriber can
We’re required to make formulary change notices available to you. You can find those notices below.
You can ask us to make an exception to our coverage rules. There are several types of exceptions you can ask for, including:
- Covering your drug if it isn’t on the drug list
- Waiving our coverage limits on your drug
- Asking us to cover your drug under a different cost-sharing tier
If we approve your request, your medicine will be covered even if it’s not on the drug list.
Get one-on-one help from a pharmacist to be sure you’re getting the most out of your medications. MTM is available at no cost as part of your prescription drug coverage with any HealthPartners Medicare Advantage plan.
Those with a limited income may be able to get help paying for their Part D prescription drug costs through the Medicare Extra Help program. (You may also hear this called a low-income subsidy, or LIS.)
If you qualify, Medicare could pay a significant portion of your drug costs, including monthly prescription drug premiums, annual deductibles and coinsurance. We follow the Centers for Medicare & Medicaid Services’
To find out if you qualify for a low-income subsidy, you can:
- Go online to
- Call Social Security at
800-772-1213(TTY 800-325-0778), 8 a.m. to 7 p.m. CT, Monday through Friday
- Visit your local Social Security office
- Contact your Medical Assistance (Medicaid) office
If you qualify, this chart shows your subsidized monthly premiums based on your level of extra help. (This does not include any Medicare Part B premium you may have to pay.)
|Your level of extra help||Journey Pace||Journey Stride||Journey Dash (Metro-Central)||Journey Dash (Greater MN)||Journey Steady||Robin Birch||Robin Maple||MSHO|
HealthPartners will provide transitional medications to:
- New enrollees to HealthPartners Medicare Part D plans as of January 1, following the Annual Enrollment Period (AEP)
- Newly eligible Medicare beneficiaries from other coverage
- Individuals who switch from one plan to another after January 1
- Enrollees residing in long-term care (LTC) facilities
- Enrollees residing in LTC facilities who have changes in level of care. For example, those entering an LTC facility or being discharged from a hospital. In this situation, early refills will be granted due to changes in an enrollee’s level of care (when appropriate)
- Continuing enrollees affected by negative formulary changes from one contract year to the next
HealthPartners will provide a one-time, temporary supply of non-formulary Part D drugs in order to accommodate the immediate needs of an enrollee. Non-formulary drugs include:
- Part D drugs that are not on the HealthPartners formulary
- Part D drugs that are on the HealthPartners formulary but – under HealthPartners utilization management rules – require prior authorization, require step therapy or have an approved quantity limit lower than the enrollee’s current dose
Our transition policy provides a one-time temporary fill of at least one month's supply of medication at the retail setting anytime during the first 90 days of enrollment in a plan. (Exception: If the enrollee presents a prescription written for less than one month’s supply, HealthPartners will allow multiple fills to provide up to a total of one month of medication.) This 90-day period begins on the enrollee’s effective date of coverage or, for continuing enrollees, the first 90 days of the contract year.
One month allows the plan and/or enrollee sufficient time to work with the prescriber to either switch to a therapeutically equivalent medication on the HealthPartners drug list or complete an exception request to maintain the coverage of the non-formulary drug based upon medical necessity reasons.
The cost sharing for one-time transitions will never exceed an enrollee’s maximum copayment or coinsurance amounts (including an enrollee’s low-income subsidy amounts, if eligible). Cost sharing will be based on the applicable tier of the non-formulary drug labeled, meaning brand drugs will process under the brand copay, when appropriate.
HealthPartners will send written notice to an enrollee within three business days of a transition fill, indicating:
- An explanation of the temporary nature of the transition supply an enrollee has received
- Instructions for working with HealthPartners and the enrollee’s prescriber to identify therapeutic alternatives, when available and appropriate
- An explanation of the enrollee’s right to request a formulary exception
- Description of the procedures for requesting a formulary excpetion
Last updated January 2022
H2462 H4882_001601 Accepted