Citrus :: Part D

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Citrus Health Care is a health plan with a Medicare contract and stand-alone PDP.
Citrus Health Care has its roots firmly planted in Florida. With headquarters in central Florida, we are staffed by people just like you, who live here and understand the needs of the local communities we serve. When you join Citrus Health Care, rest assured you will never call another state or another country when inquiring about your health. With Citrus Health Care, all of your Medicare benefi ts are delivered through a comprehensive network of local physicians and hospitals. Plus, take advantage of additional benefits not typically covered by Medicare or most Medicare supplements.

Do you want to know if your prescription medication is covered by CitrusCare plan?
Our formulary is a list of drugs, both brand names and generics which are covered by the Citrus Health Care. The medications listed on the following formularies have been reviewed by the our Pharmacy and Therapeutics (P&T) committee, and have been established to be appropriate for formulary inclusion on the basis of safety, efficacy, approved indications, ease of use, potential for adverse effects, and cost effectiveness.

If your drug is not covered and you would like to learn about alternatives that may save you money on your prescriptions, please call 1-866-769-1157 or for the hearing impaired TTY/TDD 1-888-248-7875 Monday – Friday, 8:00 AM – 8:00 PM Eastern Time.

Tier 1: Preferred Generics: Generic drugs usually cost less than brand name drugs. Generic drugs have the same active ingredients as its brand name equivalent and the FDA has rated these drugs to be as safe and effective as brand name drugs. Preferred Generics are covered during the coverage gap.

Tier 2: Generics: Although these drugs are not on Citrus Health Care’s preferred generic list, you can continue to use these drugs but may have to pay more money out of pocket.

Tier 3: Plus Brands: Citrus Health Care covers these drugs for certain plans during the coverage gap.

Tier 4: Preferred Brands: These are brand name drugs that are preferred by Citrus Health Care.

Tier 5: Brands: Although these drugs are not on Citrus Health Care’s preferred brand list, you can continue to use these drugs but may have to pay more money out of pocket.

Tier 6: Specialty: Specialty drugs are high cost medications used to treat complex diseases. These medications usually require prior authorization and have a 33% co-payment on most plans.

Enhanced Covered Drugs:
These are drugs that are normally excluded from coverage by Medicare. Citrus Health Care covers these drugs as an added benefit for some plans and if you do not qualify for extra assistance.

2 CFR 423.120(b)(5)iii:

Part D sponsors may immediately remove from their Part D plan formularies covered Part D drugs deemed unsafe by the Food and Drug Administration or removed from the market by their manufacturer without meeting the requirements of paragraphs (b)(5)((i)) of this section. Part D sponsors must provide retrospective notice of any such formulary changes to affected enrollees, CMS, State Pharmaceutical Assistance Programs, entities providing other prescription drug coverage, authorized prescribers, network pharmacies and pharmacists consistent with the requirements of paragraphs (b)(5)(ii)(A), (b)(5)(ii)(B), (b)(5)(ii)(C), and (b)(5)(ii)(D) of this section.

3/17/2010