2025 Hamaspik Medicare Select (HMO D-SNP) and Hamaspik Medicare Choice (HMO D-SNP)

Welcome

We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

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 Member Services for more information.

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, even if you haven’t paid your deductible. Please note that if you receive “extra help” with your prescription drug costs, you will pay the amounts that are outlined in Chapter 6 your Evidence of Coverage.

What is a Formulary?

A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Printable Files

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CY25 ENGLISH PRINTABLE FORMULARY
CY25 ENGLISH LARGE PRINTABLE FORMULARY
CY25 SPANISH PRINTABLE FORMULARY
CY25 LARGE SPANISH PRINTABLE FORMULARY
CY25 BENGALI PRINTABLE FORMULARY
CY25 BENGALI LARGE PRINTABLE FORMULARY
PRIOR AUTHORIZATION
STEP THERAPY
Machine Readable Drugs JSON

How to Search For Drugs

• Use the alphabetical list to search by the first letter of your medication.
• Search by typing part of the generic (chemical) and brand (trade) names.
• Search by selecting the therapeutic class of the medication you are looking for.

How to Request an Exception

You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:

You can ask us to cover your drug even if it is not on our formulary.

You can ask us to waive coverage restrictions or limits on your drug.

You can ask us to provide a higher level of coverage for your drug.

You should contact us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescribing physician’s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get your prescribing physician’s supporting statement.