You are viewing services for 2022 Medicare Advantage Coverage

View 2023 Medicare Advantage for this page

Speak with a Medicare Advantage advisor at (866) 350-2715

Please call our Customer Service team at (855) 645-8448 (TTY 711). Hours of operation are 8 a.m. to 8 p.m. CT, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CT, Monday through Friday from April 1 - Sept. 30.

Pharmacy Benefits Manager

Navitus Health Solutions is a pharmacy benefit manager (PBM). A PBM primarily provides the pharmacy claims processing platform and supports administrative services for the pharmacy portion of health care benefits. Navitus will work with Memorial Hermann Health Plan and network pharmacies to provide cost-effective prescription drug benefits for Memorial Hermann Health Plan members and to improve member health and minimize their out-of-pocket costs.

A pharmacy benefit manager (PBM) processes and pays prescription drug claims for its members. It contracts with pharmacies and builds and maintains drug formularies. A PBM also negotiates discounts and rebates with drug manufacturers.

Navitus Health Solutions is our pharmacy benefit manager and manages the pharmacy benefits on behalf of Memorial Hermann Health Plan and its members.

Pharmacy Network

Members can call our Customer Service line to ask specific questions on pharmacies and prescriptions that they are taking. You can find more information on network pharmacies by clicking here.

Memorial Hermann Specialty Pharmacy and Lumicera Specialty Pharmacy are just two specialty pharmacy vendors that Memorial Hermann Health Plan is using. Members can use any in-network specialty pharmacy vendor of their choice.

Look in the Pharmacy Locator on Memorial Hermann Health Plan’s website or call Customer Service at (855) 645-8448 (TTY 711) for additional information. Hours of operation are 8 a.m. to 8 p.m. CT, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CT, Monday through Friday from April 1 - Sept. 30.

Customer Service and ID Cards

They can call Memorial Hermann Health Plan Customer Service at (855) 645-8448 (TTY 711) for additional information. Hours of operation are 8 a.m. to 8 p.m. CT, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CT, Monday through Friday from April 1 - Sept. 30.

All ID cards will be sent out prior to Jan. 1, 2022. If you don’t receive an ID card by then, please call Memorial Hermann Health Plan Customer Service at (855) 645-8448 (TTY 711) for additional information. Hours of operation are 8 a.m. to 8 p.m. CT, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CT, Monday through Friday from April 1 - Sept. 30.

Coverage Determination

No, any current prior authorizations that are approved will remain in place for the length of the approval period. New members to the plan may need to request a new coverage determination.

No, any current approved exceptions will remain in place for the length of the approval period.

Formulary

Yes, the formulary may change each month. We encourage members to check the new formulary online for the latest information or call Memorial Hermann Health Plan Customer Service at (855) 645-8448 (TTY 711) for additional information. Hours of operation are 8 a.m. to 8 p.m. CT, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CT, Monday through Friday from April 1 - Sept. 30.

Yes, we have introduced new tiers and certain medications for diabetes, blood pressure, and cholesterol are available at no cost to you. Please check the formulary online or call Memorial Hermann Health Plan Customer Service at (855) 645-8448 (TTY 711) for additional information.

Depending on your medication, a 90 day medication refill may provide additional savings for you. Please check with your doctor to see if a 90 day prescription is appropriate for you.

Coverage Gap

The Coverage Gap, also known as the “Donut Hole”, is reached after meeting your initial coverage limit of $4,430 for 2022 plan year. While in the coverage gap, you pay discounted prices for Memorial Hermann Advantage HMO Formulary drug coverage – 25% of the cost of brand name drugs and 25% for generic drugs – until you meet your yearly out-of-pocket maximum drug cost of $7,050 in 2022. Tier 6 Select Care drugs are fully covered during the Coverage Gap and you may pay as low as $0.00 copay when you fill at a preferred pharmacy. Please see below for additional resources:

After your total yearly drug costs reach $7,050 in 2022, you enter the catastrophic coverage phase and will pay either 5% of the cost for each of your drugs (coinsurance), or $3.95 for generic drugs and $9.85 for brand-name drugs (whichever is greater) for the remainder of the year.

MTM Services

MedWiseRx™ (formerly SinfoniaRx) is working to provide Medication Therapy Management (MTM) services to our members. This service is absolutely FREE for our members and enables them to improve their health, optimize their medications, and address any concerns with a pharmacist.

Medication Therapy Management (MTM) is a free program offered by Medicare Part D plans to certain members to help improve their medication use so they can better manage their chronic conditions (e.g., diabetes, high blood pressure and high cholesterol) and improve their overall health.

Read more about our MTM program here.

You can call MedWiseRx directly via phone toll free at (844) 866-3735 (TTY/TDD: (800) 367-8939). The hours of operation is from Monday to Friday 9 a.m. to 7 p.m. CT.

Yes, you can call MedWiseRx directly via phone toll free at (844) 866-3735 (TTY/TDD: (800) 367-8939) and request to opt out of the program.

Yes, you can read more about the MTM program on our website by clicking here.  You can also visit SinfoniaRx to learn more about the benefits of having MedWiseRx on your side.

Yes, we are here to help. Please call the Customer Service department phone number at (855) 645-8448. The hours of operation are 8 a.m. to 8 p.m. CT, 7 days a week from Oct. 1 - March 31 and 8 a.m. to 8 p.m. CT, Monday through Friday from April 1 - Sept. 30.

Costco Mail Order FAQ

Costco Mail Order services is the preferred Mail Order Pharmacy for Navitus and Memorial Hermann Health Solutions. Members will need to setup a new account online or call Costco Customer Service. It is easy to begin using Costco Mail Order Pharmacy. You can register online by clicking here. Please allow at least 14 calendar days from the day you submit your order to receive your medication(s). You do not need to be a Costco member to use Costco Mail Order Pharmacy.

Memorial Hermann Health Plan and Navitus Health Solutions have partnered with Costco Mail Order Pharmacy to provide your mail order prescription benefits. Members can also use any in-network pharmacy vendor of their choice.

No. You don't need to be a Costco Member to use Costco pharmacies, including Costco Mail Order Pharmacy.

You can register via mail or phone or via online. Below are the two methods to register for home delivery service with Costco mail order pharmacy.

Option 1: Traditional Mail Order Process - If you register for Costco using mail or phone process, it is called the Traditional Mail Order. Traditional Mail Order requires you to order all your prescriptions via mail or phone. Please contact Costco Mail Order Pharmacy at (800) 607-6861 and they can help you create your account.

Option 2: Online Ordering service requires you to order all your new prescriptions online at www.costco.com. You should create an online account. Please remember that each individual receiving medications must have their own unique email address in order to create an online account. All communication between you and the pharmacy will be done via email. For assistance with creation of the Costco account, please contact Costco Mail Order Pharmacy at (800) 607-6861.

Yes, please reach out to Costco Mail Order Pharmacy, they allow members to enroll in the automatic refill program. Please be aware that prescriptions on auto-refill will still require your consent before we can fill them. A valid email address and payment method must be on file with Costco Mail Order Pharmacy in order to use the auto-refill system. To enroll your prescription in the auto-refill program, you can either enable auto-refill for each prescription yourself on the Refill Prescriptions page on the online Costco Mail Order Pharmacy account, or Contact Costco Mail Order Pharmacy via phone at (800) 607-6861. Please note auto-refills will not be available for controlled substances and refrigerated medications.

Back to top ^