Mvp health care medicare part d tier 5 select care $0 generic drugs and vaccines
2014 MVP $0-COST GENERIC DRUGS
To Control Blood Pressure To Treat Heartburn / Ulcers
atenolol tabs benazepril/hydrochlorothiazide tabs
To Treat Osteoporosis / Bone Health
bisoprolol fumarate/hydrochlorothiazide tabs bisoprolol fumarate tabs
To Treat Mental Health Conditions
fluoxetine caps, tabs, and oral solution
enalapril maleate/hydrochlorothiazide tabs enalapril maleate tabs
To Treat Glaucoma
^ Other forms of timolol solution (i.e. gel-
forming) are in Tier 1 - Preferred Generic Drugs.
$0-COST MVP SELECT To Treat Pain
losartan potassium/hydrochlorothiazide tabs
GENERIC DRUGS & VACCINES
propranolol/hydrochlorothiazide tabs propranolol tabs
To Control High Cholesterol
When you choose a 2014 MVP Medicare Advantage plan with Part D, many
triamterene/hydrochlorothiazide caps and tabs
To Treat Thyroid Conditions
commonly used Part D prescription drugs and vaccines are available to you for
To Treat Diabetes
free. You pay nothing — $0 — for our Tier 5 Select Care Drugs and select vaccines.
Miscellaneous What could you save? A lot.
Talk it over with your doctor. See if you both agree
that one of MVP’s $0 cost drugs would be right for you.
glyburide tabs metformin tabs metformin ER tabs (generic Glucophage XR only)
Refer to the MVP Health Care Formulary a for the most up-to-date
$0-cost generic drugs do not apply for the BasiCare PPO plan.
list of Medicare Part D covered drugs and other helpful prescription information.
This is not a complete list of drugs covered by our plan. For a complete listing, please call MVP’s Medicare Products Advisors
Always talk with your doctor fi rst!
Do not stop taking a prescribed medication before consulting with your doctor.
Save even more. Switch and save!
These common vaccines also are available from MVP at no cost to you when
Here are just a few of the brand name drugs that you can switch
you receive them at your local pharmacy or your doctor processes your
for a $0 cost generic. Available at no cost all year long!
Vaccines If you’re taking this Ask your doctor You could save brand name drug about this $0 cost this much per year For shingles generic drug by switching to a For tetanus and combination $0 generic drug* tetanus / diphtheria / pertussis Glaucoma $420 - $1,080
To ensure that you pay $0 for your vaccine, always ask your doctor to process your Part D
vaccine claims through a service called TransactRx. If your doctor does not process your
claim using TransactRx, you will have to pay out-of-pocket for your vaccine and submit the claim to Express Scripts for reimbursement. MVP will reimburse vaccine claims up to MVP’s
allowed amount. If your doctor chooses to charge more than the allowed amount, you
will be responsible for paying the difference. Not all providers use the TransactRx service. Check with your doctor before getting your vaccine.
Heartburn $420 - $1,080 or ulcers Less really is more. $0 drugs save you money. Are you Medicare eligible? Looking to switch plans?
You can enroll from Oct. 15 – Dec. 7 during the annual Open Enrollment period.
High blood $420 - $1,080 Almost 65? Over 65 and getting ready to retire? Moving into or new to the area? pressure
Our licensed MVP Medicare Products Advisors are ready to answer your questions
and help you enroll Monday – Friday, 8 am – 5 pm Eastern Time at
1-888-280-6205
Already an MVP member? Call our Medicare Customer Care Center with your questions
Monday – Friday, 8 am – 8 pm and Saturday, 8 am – 4 pm at 1-800-665-7924.
From Oct. 1 – Feb. 14, call seven days a week, 8 am – 8 pm.
High cholesterol $420 - $1,080
Reference to any brand name products does not constitute an endorsement or recommendation. This information is not an attempt to replace professional medical advice. Please talk with your doctor
or pharmacist if you have any questions about taking generic drugs.
Osteoporosis $420 - $1,080 (frail bones)
MVP Health Plan, Inc. is a not-for-profit HMO-POS/PPO organization with a Medicare contract.
Enrollment in MVP Health Plan depends on contract renewal. The benefit information provided is a brief
summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions apply. Benefits, formulary, pharmacy network, provider network, premium
^ Other forms of timolol solution (i.e. gel-forming) are in Tier 1 - Preferred Generic Drugs.
and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your
*If your coverage is through your former employer, your savings may vary.
Part B premium. Medicare evaluates plans based on a 5-Star Rating system. Star Ratings are calculated each year and may change from one year to the next.
Patient's Last name First name Middle initial Home address City, State, Zip code ________________________________ Email Address: __________________________________________________________________________________ What concerns do you have about your teeth? How do you feel about orthodontic treatment? Who suggested that you might need orthodontic treatment? Describe any previous orthodontic tr
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