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PRESCRIPTION BENEFITS  
   
 

HAP Senior Plus-Expanded Network gives you coverage for today's needs and protection for unexpected expenses tomorrow.

Which option is right for your needs?

If you would like to download and print a copy of the chart, click here. (requires Adobe Reader You are now leaving HAP's Medicare-approved website )

All drug prices are based on the HAP-negotiated price. You pay the lower of your copay, or the actual cost of a covered drug.

† Brand deductible only applies to Tiers 3, 4, and 5.
* A 90-day supply is available on most prescriptions filled through mail-order or select pharmacies at
2-1/2 times the applicable 30-day copay.
** Excludes monthly premiums and costs of non-covered drugs, including costs of drugs purchased outside the U.S.
*** For Generic drugs purchased in the Coverage Gap:

• With Option 1 or Option 2 - you pay 72% of our negotiated price
• With Option 3 - you pay whichever is lower: the fixed copay or 72% of our negotiated price

For all Brand-name drugs purchased in the Coverage Gap:

You pay 47.5% (less than half) of our negotiated price, plus the applicable pharmacy dispensing fee. Even though you pay only part of the costs, the full cost of Brand-name drugs counts toward your annual total out-of-pocket cost for prescription drugs. This means you may exit the Coverage Gap and enter the Catastrophic Coverage period with its enhanced benefits more quickly

CONVENIENT PHARMACIES
HAP Senior Plus-Expanded Network plans that include prescription drug benefits cover both Brand-name and Generic prescription drugs at thousands of pharmacies in our network, which includes:

• Retail (some provide free home delivery)
• Mail-order
• Medical center
• Long-term care
• Indian Health, Tribal, and Urban pharmacies

If you travel, you can get your prescription drugs at any network pharmacy with nationwide locations
(like CVS or Kmart).

Generally, you must get your prescription drugs at a pharmacy in our nationwide network, except in emergency or urgent care situations.

We will cover prescriptions that are filled at a non-network pharmacy if the prescriptions are related to care for a medical emergency or urgently needed care. In this situation, you will have to pay the full cost (rather than just the copay) when you fill your prescription. In addition to your normal copay, you will be responsible for any costs incurred above the HAP negotiated pharmacy rate. Quantity limitations and restrictions may apply. We cannot pay for drugs purchased outside the United States, even for a medical emergency.

Pharmacy Directory
View our affiliated pharmacy directory online.

GETTING EXTRA HELP FOR PRESCRIPTION DRUG COVERAGE
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:

• 1-800-MEDICARE (1-800-663-4227), TTY users should call (877) 486-2048,
24 hours a day, seven days a week;
• The Social Security Administration at (800) 772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call (800) 325-0778 or
•Your state Medicaid office

Learn more about getting Extra Help

Your HAP representative can help you with:

• Your options
• Our formulary
• Our pharmacy network

PROSPECTIVE MEMBERS: FOR MORE INFORMATION ABOUT OUR PRESCRIPTION DRUG BENEFITS, CALL US TOLL-FREE AT:
(800) 868-3153 or
TTY/TDD (800) 649-3777

EXISTING MEMBERS: FOR PHARMACY AND MAIL-ORDER PHARMACY INFORMATION,
CALL TOLL-FREE:
HAP Senior Plus
(800) 801-1770 or
TTY/TDD (800) 649-3777

Office hours:
Monday through Friday, 8 a.m. to 8 p.m.
Saturday, 8 a.m. to noon.
At all other times, you may access our Interactive Voice Recording system at the same number and leave your name and phone number. A HAP Medicare Customer Service Representative will return your phone call the next business day.

Extended hours from October 1 through February 14:
7 days a week, 8 a.m. to 8 p.m.

You can also write to us at:
HAP Client Services
Attn: Medicare
2850 W. Grand Boulevard
Detroit, Michigan 48202

IMPORTANT INFORMATION
HAP Senior Plus (hmo) is a health plan with a Medicare contract. Enrollment in the plan depends on contract renewal. Generally, your HAP Senior Plus-Henry Ford prescription drug benefits are only available at contracted network pharmacies, except in emergency or urgent care situations. HAP Senior Plus-Henry Ford members must receive prescription drug coverage through their plan. If you enroll in a stand-alone prescription drug plan, you will lose your HAP Senior Plus-Henry Ford benefits.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply.  Benefits, formulary, pharmacy network, premiums and/or copayments/coinsurance may change on January 1 of each year.

 
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