Medicare & Long-Term Care Prescription Drug Benefits

Whether you’re looking for an in-network pharmacy in your area, need to see if a prescription is covered, or want to learn about your Medicare prescription drug coverage, Healthfirst can help.

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Understanding your prescription benefits Maximizing your prescription benefits Understanding your coverage Helpful reminders

Understanding your prescription benefits

All Healthfirst Medicare Advantage plans offer a low or no copay and no deductible for preferred generic drugs (Tier 1). Copays and deductibles vary for other drug tiers, depending on your plan. To see your specific coverage and costs, log in to your account at MyHFNY.org.

Maximizing your prescription benefits

We know managing your prescriptions can be overwhelming at times, and Healthfirst is here to help in a number of ways.

Medication Therapy Management Program

This free service for eligible Healthfirst members helps you manage multiple prescriptions. A licensed pharmacist thoroughly reviews all your medications, answers any questions you may have, and can work with your doctor on any adjustments you may need.

Medication Therapy Management Program

90-day mail order - Caremark

You may save time and money with Caremark’s mail-order service by getting a 90-day supply of certain medications mailed right to your home.

Caremark mail-order service

Medicare Prescription Payment Plan

While this option doesn’t lower your Medicare Part D drug costs, it can help you manage them. It lets you spread your costs across the calendar year (January–December) so instead of having to make one large payment, you can make smaller monthly payments.

Medicare Prescription Payment Plan

Understanding your coverage

To better understand how your prescription drug coverage works and what determines various costs, please review the information below.

Generic vs. brand

According to the FDA, generic drugs must have the same active ingredient, strength, quality, and safety as the brand-name drug. So generics are just as safe and effective as brand-name drugs but often cost much less.

Prior authorization

For some prescription medications, your doctor may need to get prior authorization from us before they can be filled. We do this to make sure you aren’t prescribed a drug that could counteract another drug you’re on. We also may request that a generic drug be prescribed over the more expensive brand drug so you can save money.

Out-of-pocket costs

Depending on which Healthfirst Medicare Advantage plan you have, you may have to pay some out-of-pocket costs for your medications. These costs could include a deductible or a copay and are based on your plan type, drug tiers, and other factors.

Drug tiers

Prescription drugs are grouped into different levels called “tiers”. Depending on your plan, there may be multiple tiers, with Tier 1 (preferred generic drugs) often being the lowest-cost tier. Often the amount you pay depends on the specific drug tier as well as your plan type.

Deductibles

While Healthfirst Medicare Advantage plans have no deductible for Tier 1 drugs (preferred generics), drugs in other tiers could have a deductible. If your plan has a deductible for some medication, you will need to pay the full amount of that prescription medication until you reach your deductible amount. Then, depending on your plan, we’ll pay for some or all of the medication for the rest of the year.

Coverage stages

There are three annual stages of prescription drug coverage that impact your out-of-pocket costs. Stage one is for those who have an annual deductible, stage two is your coverage after any deductible is met, and, for those who spend enough out-of-pocket to reach stage three, catastrophic coverage would kick in and your plan would pay the cost of your drugs for the rest of the year.

Savings programs

If you’re a Healthfirst Medicare Advantage member and meet certain income requirements, the Elderly Pharmaceutical Insurance Coverage (EPIC) program could help you pay out-of-pocket drug costs and premium payments. You may also qualify for the Extra Help program, which also provides help with paying for your drugs.

Learn more about EPIC Learn more about Extra Help

HIV prevention

If you are on Medicare and are at increased risk of getting HIV (as decided by your doctor or healthcare provider), Medicare Part B fully covers your HIV prevention medication.

Helpful reminders

Healthfirst helps you get healthy, and stay healthy, by providing the medications you need, when you need them.

Your coverage

All Healthfirst Medicare Advantage plans include Part D coverage, which helps cover some or all of your prescription drug costs. To see your plan’s specific prescription benefits, log in to your account.

Log in

90-day prescriptions

If you’d like the ease of refilling your medications every three months instead of every month, ask your doctor about 90-day prescriptions. In many cases, they may even cost less per day than 30-day supplies.

Still have questions?

We can help you manage your ­­medications, so you stay on track with your refills. Our Healthfirst Pharmacy Team is here to help.

Call 1-844-347-2955

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.

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