Pharmacy

Welcome to Tufts Health Plan Medicare Preferred's Pharmacy page. Here you can locate prescription drugs on our formulary and use our pharmacy finder. Take a look at the information below.

Tufts Health Plan Medicare Preferred uses a Formulary to list the prescription drugs that we cover. Follow the instructions below to find the drug you are looking for.

Finding your drug on the Formulary (Drug List) :

1. Search a copy of the Tufts Medicare Preferred HMO Individual Formulary PDF click here
2. Search using the Tufts Medicare Preferred HMO Formulary Online Tool click here
3. Search a copy of the Tufts Medicare Preferred HMO Employer Group 2012 Formulary click here
4. Search using the Tufts Medicare Preferred HMO Employer Group 2012 Formulary Online Tool click here
5. Search a copy of the Tufts Medicare Preferred PDP Group Retiree 2012 Formulary click here
6. Search using the Tufts Medicare Preferred PDP Group Retiree 2012 Formulary Online Tool click here

Changes and Updates

Tufts Health Plan Medicare Preferred may add or remove drugs from our formulary during the year. The cover page of the posted formulary includes the last date the document was updated. For questions call Customer Relations.

Click here to view the Prescription Drug Transition Process

Pharmacy Directory

Tufts Health Plan Medicare Preferred has contracts with over 850 pharmacies within the service area. The link below provides a list of Tufts Health Plan Medicare Preferred participating pharmacies. This directory is updated daily, however this does not guarantee the pharmacy is still in the network. Please call Customer Relations.

Pharmacy Finder

For a list of Tufts Health Plan Medicare Preferred participating retail, mail order, home-infusion, and long-term care pharmacies, as well as toll-free numbers for participating national chain pharmacies:

HMO Pharmacy Directory click here

Our Pharmacy Finder gives you a complete list of our network pharmacies - that means all of the pharmacies that have agreed to fill covered prescriptions for our plan members. In most cases, your prescriptions are covered only if they are filled at the plan's network pharmacies (retail or mail-order). Tufts Health Plan Medicare Preferred has contracts with Pharmacies that equal or exceed requirements for pharmacy access in your area.

If you are traveling within the U.S., but outside of the Plan's service area and you become ill or if you lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy if you follow all other coverage rules identified within your Evidence of Coverage and a network pharmacy is not available. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill the prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form.

There may be other times you can get your prescription covered if you go to an out-of-network pharmacy. We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:

1. If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service
2. If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).

Before you fill your prescription in either of these situations, call Customer Relations to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of-network pharmacy for the reasons listed above, you will have to pay the full cost (rather than just paying your copayment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form

Extra Help

If you qualify for extra help, your premium and drug costs will be lower. When you join a plan offered by Tufts Health Plan Medicare Preferred, Medicare will tell us how much extra help you are getting. Then, we will let you know the amount you will pay. The premiums listed do not include any Part B premium the member may have to pay. The premiums listed are for both medical services and prescription drug benefits.

1. Click here to view 2012 HMO Prime Rx Plus Premium Changes for Low Income Subsidy
2. Click here to view 2012 HMO Prime Rx Premium Changes for Low Income Subsidy
3. Click here to view 2012 HMO Value Rx Premium Changes for Low Income Subsidy
4. Click here to view 2012 HMO Basic Rx Premium Changes for Low Income Subsidy

Beneficiaries interested in qualifying for extra help with Medicare Prescription Drug Plan costs should call:

1. The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778
2. 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048 (24 hours a day/7 days a week) or
3. Your State Medicaid Office

Universal Pharmacy Form

This form is used to request coverage for medications that require prior authorization, exceptions for non-covered drugs, or tier exceptions. Your physician must be involved in filling out this form since he or she will need to provide information regarding the medical necessity of your request.

1. Click here to download the Universal Pharmacy Form
2. Click here If your physician prefers the alternative Coverage Determination Request form

Appeals and Grievances

Interested in learning more about the aggregate number of appeals, grievances and exceptions filed with Tufts Health Plan Medicare Preferred? Call Customer Relations for a copy of our Tufts Medicare Preferred HMO Appeals and Grievances Report.