Viva Medicare Extra Care (HMO SNP)

Pharmacy Directory, Drug Search and Information

Viva Medicare Extra Care Pharmacy Directory

The national Viva Medicare Pharmacy network for Viva Medicare Extra Care includes an extensive network of both local pharmacies and national chains.

The national Viva Medicare networks equal or exceed the requirements of the Centers for Medicare & Medicaid Services (CMS) for pharmacy access. Please review the information in the front of the pharmacy directory to learn more about how to fill prescriptions and when you can use an out-of-network pharmacy.

List of Covered Drugs (Formulary)

Formularies (lists of covered drugs) offer members access to both generic and brand name drugs. The formulary includes prescription drugs in every therapeutic class and category. Please review the information in the formulary introduction to learn more about the Viva Medicare Rx drug benefit – including how to ask for an exception if your drug is not on the formulary, has a coverage restriction, or is covered as a non-preferred drug.

NOTE: Look up your medication in the index in the back. Then go to that page number to see the drug's tier. The amount you pay for drugs depends on which Viva Medicare plan you are on. Copays are listed in the front of your formulary.

Each October, all current members who are on a plan that includes Part D coverage are notified that the formulary for the next calendar year is available on our website. Members can find information regarding any mid-year non-maintenance formulary changes to the printed formulary, as well as Prior Authorization and Step Therapy criteria, by looking below or calling Member Services. You can also review your monthly Part D Explanation of Benefits (EOB) to see which of the drugs you are currently taking are coming off the Viva Medicare formulary. If you want the formulary for your plan mailed to you, call Member Services.

Important Message About What You Pay for Vaccines
Our plan covers most Part D vaccines at no cost to you. 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, no matter what cost-sharing tier it’s on.

Pharmacy Policies

Drugs Requiring Prior Authorization

We require you to get prior authorization for certain drugs that are on our formulary. These drugs have a "PA" next to them in the formulary. This means that you will need to get approval from us before you fill these prescriptions or we may not cover the drug. Ask your doctor to complete the form below and submit it for approval before you go to the pharmacy if you need a drug that requires prior authorization.

Transition Policy

If your drug is not on the Drug List or is restricted, here are things you can do:

• You may be able to get a temporary supply of the drug (only members in certain situations can get a temporary supply). This will give you and your provider time to change to another drug or to file a request to have the drug covered.
• You can change to another drug.
• You can request an exception and ask the plan to cover the drug or remove restrictions from the drug.

Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. To be eligible for a temporary supply, you must meet one of changes listed in Requirement 1 and one of the situations described in Requirement 2 below:

1. The change to your drug coverage must be one of the following types of changes:
• The change to your drug coverage must be one of the following types of changes:
• Your drug is now restricted in some way
2. You must be in one of the situations described below:
• For those members who aren't in a long-term care (LTC) facility and were in the plan last year or are new to the plan:
  We will cover a temporary supply of your drug during the first 90 days of the calendar year (current members) or during the first 90 days of your membership (new members). This temporary supply will be for a maximum of 30 days. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication. The prescription must be filled at a network pharmacy.
• For those members who reside in a long-term care (LTC) facility and were in the plan last year or are new to the plan:
  We will cover a temporary supply of your drug during the first 90 days of the calendar year (current members) or during the first 90 days of your membership (new members). The total supply will be for a maximum of 91 days and may be up to a 98-day supply. If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 91 days of medication. (Please note that the long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)
• For those members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away:
  We will cover one 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.
• Current members with unplanned transitions:
  Current members that experience unplanned transitions as a result of a change in treatment settings (e.g., such as moving from a hospital to a long term care facility, to home or to a skilled nursing facility or those leaving a skilled nursing facility) can request a formulary exception to continue their current non-formulary drug. In these situations, the plan will consider allowing a member a one-time temporary or emergency supply so that the member does not experience a coverage lapse while proceeding through the exceptions process.

To ask for a temporary supply, call Member Services at the number on the bottom of this page. During the time when you are getting a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug.

Drug Safety Information

Part B Drug Step Therapy

Effective January 1, 2022, Viva Health added a Medical Preferred Drug Program with Step Therapy requirements for our Medicare Advantage members. The link below is the list of drugs that will be subject to these requirements.