List of Covered Drugs

The List of Covered Drugs (Formulary) is a list of drugs that are covered by HAP Empowered MI Health Link (Medicare-Medicaid Plan).
  • HAP Empowered MI Health Link is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees.
  • Benefits, the List of Covered Drugs, and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year.
  • Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration (FDA). HAP Empowered MI Health Link covers both brand name drugs and generic drugs.
  • Covered Drugs are available at pharmacies within our network. A pharmacy is in our network if we have an agreement with them to work with us and provide you services. We refer to these pharmacies as “network pharmacies.”
  • You can always check HAP Empowered MI Health Link’s up-to-date List of Covered Drugs. To view the HAP Empowered MI Health Link Formulary, click on the link below.
The HAP Empowered MI Health Link Formulary (List of Covered Drugs) is available for free in other formats such as large print, braille or audio. Call HAP Empowered MI Health Link Customer Service at (888) 654-0706 (TTY: 711) seven days a week, 8:00 a.m. to 8:00 p.m. The call is free.

You can get this information, now and in the future, for free in other languages or other formats such as large print, braille, or audio. Call HAP Empowered MI Health Link Customer Service at (888) 654-0706 (TTY: 711), 7 days a week, 8 a.m. to 8 p.m. The call is free.
  • You can search alphabetically (if you know how to spell the drug); or
  • You can search by medical condition.
To search alphabetically, go to the Index of Covered Drugs section. Search using the brand or generic name of the drug. Look in the Index and find your drug. Next to your drug you will see the page number where you can find coverage information. Go to that page and find the name of your drug in the first column of the list. To search by medical condition, find the section labeled “List of Drugs by Medical Condition”. The drugs in this section are grouped into categories depending on the type of medical conditions they are used to treat. For example, if you have a heart condition, you should look in the category, Cardiovascular. That is where you will find drugs that treat heart conditions.

2018 HAP Midwest Health Plan Comprehensive Formulary and utilization management information
2019 List of Covered Drugs
2019 Prior Authorization Criteria
2019 Step Therapy


Some drugs have coverage rules or have limits on the amount you can get. In some cases you or your doctor or other prescriber must do something before you can get the drug. For example:
  • Prior approval (or prior authorization): For some drugs, you or your doctor or other prescriber must get approval from HAP Empowered MI Health Link before you fill your prescription. If you don’t get approval, HAP Empowered MI Health Link may not cover the drug.
  • Quantity limits: Sometimes HAP Empowered MI Health Link limits the amount of a drug you can get.
  • Step therapy: Sometimes HAP Empowered MI Health Link requires you to do step therapy. This means you will have to try drugs in a certain order for your medical condition. You might have to try one drug before we will cover another drug. If your prescriber thinks the first drug doesn’t work for you, then we will cover the second.
You can find out if your drug has any additional requirements or limits by looking at the List of Covered Drugs or utilization management documents in the link above. The List of Covered Drugs has a column labeled “Necessary actions, restrictions, or limits on use.”

You may also ask us to send you a copy.

You can also ask for an exception from these limits. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to ask for an exception.

HAP Empowered MI Health Link has a transition policy to help you get your medications when you first become a member of our plan. We may cover a temporary 30-day supply of your drug during the first 90 days you are a member of HAP Midwest MI Health Link. This will give you time to talk to your doctor or other prescriber. He or she can help you decide if there is a similar drug on the Drug List you can take instead or whether to request an exception.

If your prescription is written for fewer days, we will allow multiple fills to provide up to a maximum of 30 days of medication.

We will cover a 30-day supply of your drug if:
  • you are taking a drug that is not on our Drug List; or
  • health plan rules do not let you get the amount ordered by your prescriber; or
  • the drug requires prior approval by HAP Empowered MI Health Link; or
  • you are taking a drug that is part of a step therapy restriction.
If you are in a nursing home or other long-term care facility and need a drug that is not on the Drug List or if you cannot easily get the drug you need, we can help. If you have been in the plan for more than 90 days, live in a long-term care facility, and need a supply right away:
  • We will cover one 31-day supply of the drug you need (unless you have a prescription for fewer days), whether or not you are a new HAP Empowered MI Health Link member.
  • This is in addition to the temporary supply during the first 90 days you are a member of HAP Empowered MI Health Link.
An Emergency Supply is defined by CMS as a one-time fill of a drug that is not on the list but is necessary for a current member in a long term care setting. Current members that need an emergency supply or are prescribed a drug that is not on the list as a result of a level of care change are placed in transition. Our claims processor will put an override in the system to allow the one-time fill. Level of care changes include the following changes from one treatment setting to another:
  • Enter a long term care (LTC) facility from a hospital or other setting;
  • Leave a LTC facility and return to the community;
  • Discharge from a hospital to a home;
  • End a skilled nursing facility stay covered under Medicare Part A (including pharmacy charges), and revert to coverage under Medicare Part D; and
  • Discharge from a psychiatric hospital with medication regimens that are highly individualized.

For a printed copy of the most recent list of drugs, call HAP Empowered MI Health Link Customer Service at (888) 654-0706 (TTY: 711), seven days a week, 8 a.m. to 8 p.m. The call is free.

 

HAP Midwest MI Health Link
PO Box 2578
Detroit, MI 48202