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Prescription coverage

HAP is here with zero dollar deductibles for covered prescriptions

Most HAP Medicare Advantage Plans include prescription drug coverage (or Part D) and a $0 annual prescription deductible.  Other highlights include a $0 copay for Tier 1 drugs purchased at a preferred pharmacy; and, a $0 copay for a 90-day supply of most Tier 1 and Tier 2 drugs purchased from a preferred mail order pharmacy. 

Important message about what you pay for vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Client Service for more information.

HAP is participating in a voluntary CMS model that enables us to lower our members’ out-of-pocket costs for select insulins.  Members will pay no more than $10 to $25 for a 30-day supply of select insulins during all Part D phases until the catastrophic level is reached. This benefit applies to select insulins in the Part D formulary (examples are: Novolog, Novolin, Lantus and Toujeo). Note: the insulins that are part of the Senior Savings Model Program will have SSM next to them on the formulary listing.

Important message about what you pay for insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible.

Note: This Part D Senior Savings Model is offered on all individual Medicare Advantage plans with Prescription Drug coverage for beneficiaries who do NOT have "Extra Help." HAP Medicare Complete Duals (HMO D-SNP) and employer groups are not enrolled in the SSM.

Find out if you qualify for Extra Help with prescription premium costs.

Compare prescription drug benefits and costs

If your medication is covered by your Medicare insurance, you can use our online tool Express Scripts to compare prescription drug benefits across different plans. You also can compare plan options against current medication costs to choose the plan that best meets your needs. To use Express Scripts and see if your medication is covered, select your plan type below:

Medicare Advantage Plans 2023

Medicare Advantage Plans 2022

Will my medication be covered?

If you’re shopping for a Medicare plan, you’re probably wondering if your insurance covers your prescription medication. The easiest way to tell if your medication is covered is to download the HAP Medicare formulary (PDF)Press Ctrl+F (Command+F for Mac) and type in the name of the drug to see whether it’s included in the covered drug list for your type of plan. The drug name will be highlighted.

Your Medicare Part B (Medical Insurance) does cover some outpatient prescription drugs under specific conditions. Learn more at Medicare.gov.

To be covered by the plan, you must have your prescriptions filled at either plan retail pharmacies or our mail-order pharmacies. In some cases, prescriptions filled at a non-plan pharmacy may also be covered.

For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. These requirements and limits are described in the Evidence of Coverage for each plan.

The formulary may change at any time. You will receive notice when necessary.

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.

Have Medicare questions?

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