Prescription Drugs for Clarion Health (HMO)


See how our prescription drug benefits compare.

View our Formulary:


Four Stages of Drug Coverage

Our plan groups each drug into one of six “tiers” (levels). You will need to use the formulary (list of covered drugs) to locate what tier a drug is on.


The deductible is the amount you pay before your plan starts to pay. This deductible is for retail and home delivery. There is no deductible with the Clarion Health (HMO) plan.

Initial Coverage

After you’ve reached the deductible, you’ll enter the initial coverage phase.

In this phase, you and the plan share the costs of some of the covered drugs until your total drug costs, including deductible, reach $4,020. The total drug costs paid by both you and our Part D plan will help you reach the coverage gap.

Clarion Health
hmo plan cost

With our Medicare Advantage plan, you get:

Hospital Coverage

Medical Coverage

Prescription Drug Coverage

And your monthly plan
premium is:

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Standard Retail Cost-Sharing

Standard Mail Order Cost-Sharing


If you live in a long-term care facility, you pay the same as at a retail pharmacy.
Coverage Gap

The coverage gap (also called the “donut hole”) starts after the total yearly drug cost (along with what our plan has paid and what you have paid) reaches $4,020.

While in the coverage gap in 2020, you’ll pay 25% of the plan’s cost for brand-name drugs and for generic drugs. You enter the catastrophic coverage phase once your yearly true out-of-pocket cost (Troop) reaches $6,350. The costs paid by you, and the manufacturer discount payment for brand-name drugs count toward your true out-of-pocket costs and help you get out of the coverage gap. Not everyone will reach the coverage gap.

Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $6,350, you pay the greater of: 5% of the cost or you pay $3.60

for generic (including brand-name drugs treated as generic). You pay $8.95 or 5%, whichever is greater for all other drugs.

Qualifying for Extra Help, Low Income Subsidy (LIS)

If you qualify for Extra Help for your Medicare prescription drug plan costs, the amount you pay for insurance every month and cost at the pharmacy will be lower.

The amount of Extra Help, Low Income Subsidy (LIS) level will decide the amount you pay for insurance every month as a member of our plan.

To learn more about available Medicare Part D subsidies (the money granted by the government to help pay for Part D drugs) please call:

Clarion Health at 844-824-8771, (TTY: 711); Seven days a week, 8 am to 8 pm Oct 1 - Mar 31
Monday - Friday 8am to 8pm Apr 1 - Sept 30

Or visit Social Security can also provide you with an application.


  • Chemotherapy drugs: You pay 20% of the cost
  • Other Part B drugs: You pay 20% of the cost