What is a formulary? A formulary is a list of covered drugs selected by Vantage Medicare Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.
Vantage Health Plan covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient 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.
For formulary questions, please contact Member Services at 1-888-823-1910 (TTY 1-866-524-5144 for the hearing impaired) as your drug may be covered as a generic drug under our plan.
You can search the Vantage formulary to see if your drugs are covered according to drug tier, quantity limit (QL) and if prior authorization (PA) from Vantage is required before receiving the drug.
As a member of Vantage Medicare Advantage, you have the right to request a Coverage Determination, which includes the right to request an expedited coverage determination, an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. Click here to Request Online.
You can apply for Extra Help with Medicare prescription drug costs at www.socialsecurity.gov/prescriptionhelp. You can also contact your local Social Security office or call Social Security at (800) 772-1213 or for the hearing impaired, please call TTY (800) 325-0778.
The following link to the Vantage Medicare Advantage LIS table shows the amount of Extra Help you can receive with Part D Prescription Drug cost & premiums if you qualify.
Click here for information about Transition Fills and Medical Therapy Management Programs.
Click here for information about Formulary Changes.
This page was last updated: 6/17/2019
Vantage Health Plan, Inc. is an HMO plan with a Medicare contract. Enrollment in Vantage Health Plan, Inc. depends on contract renewal.