HealthChoice Medicare Supplement Plans
Your physician may prescribe a medication that is not covered by HealthChoice. If you receive a prescription for a non-covered drug, your options are to:
- Ask your physician for a prescription for a covered medication that is listed in the HealthChoice Medicare Formulary.
- Continue with the non-covered medication and pay the full cost.
- Ask your physician to request a prior authorization for coverage of a non-covered medication.
Be aware that HealthChoice cannot cover medications that are:
- Covered under Medicare Part A or Part B
- Purchased outside the United States
- Prescribed for off-label use – this means any use of a drug other than those indicated on its label
Also, by law, the following drug categories are excluded from coverage:
- Most barbiturates
- Cough and cold medications
- Fertility drugs
- Over-the-counter drugs
- Impotency medications such as Cialis, Levitra, Viagra, and Caverject*
- Lost, stolen, or damaged medications**
- Drugs not approved by the FDA
- Drugs used for the treatment of anorexia, weight loss, or weight gain
- Drugs used for cosmetic purposes or hair regrowth
- Brand-name drugs from manufacturers that do not participate in the Coverage Gap Discount Program
- All over-the-counter and prescription vitamins – except prenatal vitamins
If you receive Extra Help from Medicare to pay for your prescriptions, the Extra Help program does not pay for medications that are excluded from coverage. Additionally, any amounts you pay for excluded drugs do not count toward your total drug costs.
*These drugs are specifically excluded from coverage unless you have had radical retropubic prostatectomy surgery or certain other medical conditions. Prior authorization is required.
**Part D covers medications lost or damaged as the direct result of a declared national disaster or public health emergency.
For more information, contact HealthChoice Member Services and ask for the Pharmacy Resolution Unit.
- 1-405-717-8780 or toll-free 1-800-752-9475,
- TDD 1-405-949-2281 or toll-free 1-866-447-0436, or
- Fax 1-405-717-8942.
Note: Not all prescriptions are covered. The law does not allow Medicare to cover certain types of drugs, and HealthChoice decided not to cover certain drugs.