Essence Advantage (HMO-POS) Formulary



Below is the 2023 Formulary, or prescription drug list, from Essence Advantage (HMO-POS) by Essence Healthcare Of Georgia, Inc. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Georgia Medicare Part-C plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you. You’ll want to make sure the medicines you are currently taking are covered under any plans you are considering enrolling in.

This Essence Advantage (HMO-POS)(H5372-001) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $4660. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 25% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" by clicking the "Coverage Gap" link above the chart.

In 2023 if you have spent $7400 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Essence Healthcare Of Georgia, Inc will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link above the chart.



Plan Overview

Plan Name:Essence Advantage (HMO-POS)
Plan ID: H5372-001
Provider: Essence Healthcare Of Georgia, Inc
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Georgia
Similar Plan:H5372-001


Change Table Options:

Drugs Starting Letter:
Coverage Phase:

*Tip Click the Drug name to Compare Coverage and Retail Cost for Every Plan In Your Area
⇅ Click the Header to Sort
Drug
Name⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Edarbi
3$42$47NANN
Edarbyclor
3$42$47NANN
Edurant
533%33%NANN
Efavirenz
2$5$10NANN
Efavirenz, Emtricitabine And Tenofovir Disoproxil
533%33%NANN
Efavirenz, Lamivudine And Tenofovir Disoproxil Fum
533%33%NANN
Egrifta Sv
533%33%NA30/30YN
Eligard
4$95$100NAYN
Eliquis
3$42$47NANN
Elmiron
4$95$100NA90/30NN
Eluryng
2$5$10NA1/28NN
Emcyt
533%33%NANN
Emend
4$95$100NA6/28YN
Emgality
3$42$47NA3/30YN
Emsam
533%33%NA30/30NY
Emtricitabine
2$5$10NANN
Emtricitabine And Tenofovir Disoproxil Fumarate
533%33%NANN
Emtriva
4$95$100NANN
Enalapril Maleate And Hydrochlorothiazide
1$0$5NANN
Enbrel
533%33%NAYN
Endocet
2$5$10NA180/30NN
Engerix-b
3$42$47NAYN
Enoxaparin Sodium
2$5$10NA60/30NN
Enpresse
2$5$10NANN
Enskyce
2$5$10NANN
Entacapone
2$5$10NANN
Entecavir
2$5$10NANN
Entresto
3$42$47NA60/30NN
Enulose
2$5$10NANN
Epclusa
533%33%NA28/28YN
Epidiolex
533%33%NAYN
Epinastine Hydrochloride
2$5$10NANN
Epinephrine
2$5$10NA4/30NN
Epitol
2$5$10NANN
Epivir
4$95$100NANN
Eplerenone
2$5$10NANN
Eprontia
4$95$100NA480/30NY
Ergoloid Mesylates
2$5$10NANN
Erivedge
533%33%NA28/28YN
Erleada
533%33%NA120/30YN
Erlotinib
533%33%NA60/30YN
Errin
1$0$5NANN
Ertapenem
2$5$10NANN
Ery
2$5$10NANN
Erythromycin
2$5$10NA180/30NN
Erythromycin Ethylsuccinate
2$5$10NANN
Esbriet
533%33%NA270/30YN
Escitalopram
1$0$5NANN
Escitalopram Oxalate
2$5$10NANN
Estarylla
2$5$10NANN
Estradiol
1$0$5NANN
Estradiol / Norethindrone Acetate
2$5$10NANN
Estradiol Transdermal System
2$5$10NA4/28NN
Estradiol Valerate
2$5$10NANN
Eszopiclone
2$5$10NA30/30NN
Ethambutol Hydrochloride
2$5$10NANN
Ethosuximide
2$5$10NANN
Ethynodiol Diacetate And Ethinyl Estradiol
2$5$10NANN
Etodolac
2$5$10NANN
Etonogestrel/ethinyl Estradiol
2$5$10NA1/28NN
Etravirine
533%33%NANN
Everolimus
533%33%NA56/28YN
Evotaz
533%33%NANN
Evrysdi
533%33%NAYN
Exemestane
2$5$10NANN
Exkivity
533%33%NA120/30YN
Eysuvis
3$42$47NA/14NN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H5372-001

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $0. Some plans offer select Pre-deductible drug Coverage
2. Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $4660
3. Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7400 in 2023.
4. Catastrophic: Anything over $7400 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2023 is $505. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Cost Preferred: Your Cost for the Drug at the Providers In-Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non-Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plan's formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on

Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

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