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. Cough and Cold Men’s Health Prescription Vitamins For instructions on how to use the Advantage MD PPO formulary
click here
. Advantage MD Group members should
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for instructions. Notice of Nondiscrimination:
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Spanish
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.
Important Message About Excluded Drug Coverage – Our plan covers the following prescription drugs which are not normally covered in a Medicare Prescription Drug Plan. These covered excluded drugs are covered under Tier 2 and include select prescription vitamins, cough and cold medications, and erectile dysfunction medicine.
-Benzonatate 100mg, 150mg, and 200mg Caps
-Brom/Pse/DM Syp 2-30-10mg/5ml
-Promethazine VC/Codeine Syrup 6.25-5-10mg/5ml
-Promethazine VC Syrup 6.25-5mg/5ml
-Promethazine/Codeine Sol 6.25-10mg/5ml
-Promethazine Sol DM
-Sildenafil Tab 25mg, 50mg, and 100mg (quantity limit of 6 tabs per 30 days)
-Folic Acid Tab 1mg
-Dodex (Cyanocobalamin 1000 mcg/ml) Inj
-Nascobal Spray 500mcg
-Vitamin B12 1 mg/ml Injectable Solution
-Vitamin D2 Cap 50,000 IU
For questions about drugs covered in the Advantage MD PPO formulary, call Customer Service toll-free at 1-877-293-5325 (TTY: 711).
You may obtain a print version of your formulary by calling us. We are available for assistance 24 hours a day, seven days a week.
John Hopkins Advantage MD is a Medicare Advantage plan with a Medicare contract offering HMO and PPO products. Enrollment in John Hopkins Advantage MD HMO or PPO depends on contract renewal.
Notice of Nondiscrimination: Johns Hopkins Advantage MD complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Foreign Language Assistance: Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1‑877‑293‑5325 (TTY: 711) Chinese: 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1‑877‑293‑5325 (TTY: 711).
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Advantage MD products are offered by Hopkins Health Advantage, Inc., a Maryland health insurer.
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