Clear Spring Health offers two Medicare Part D (or prescription drug)
plans: Value and Premier. Both include an extensive list of covered generic and brand-name prescription drugs and thousands of local
and national pharmacies.

Español

Para asistencia en español, llame al:

(877) 317-6082; TTY: 711 y oprima el número 2

Nuestro horario es

de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana.
Si llama del 1ro de abril al 30 de septiembre, se usará sistema
automatizado de voz (correo de voz) durante los fines de semana
y los días feriados.

Our Contacts

To learn more, please call

(877) 317-6082; TTY: 711

Clear Spring Health,

PO Box 278530
Miramar, FL 33027

Hours of Operation

8:00 a.m. – 8:00 p.m., 7 days a week
(Between April 1 – September 30, voicemail will be available on Saturday, Sunday and federal holidays.)

Clear Spring Health Premier Rx (PDP) – – val 

Home    >     Clear Spring Health Premier Rx (PDP) – – val

Discover the Clear Spring Health Premier Rx

Overview

Covered prescription drugs are available at retail pharmacies. Mail-order is also available for most maintenance medications.

Premium
$24.00 Monthly
Covered Prescription Drugs
Find a Covered Drug
Pharmacy
Find a Participating  Pharmacy
Pharmacy Coverage
Premium
$13.50
Pharmacy (PartD) Deductible
Tier 1 and Tier 2 – $0 Deductible Tier 3, Tier 4 and Tier 5 – $445 Deductible
Covered Prescription Drug Benefits
Pharmacy Option
Edit
.
Tier 1: Preferred Generic
Tier 2: Generic
Tier 3: Preferred Brand
Tier 4: Non-Preferred Drug
Tier 5: Specialty
Retail – Preferred Pharmacy
 
Edit
30-day supply
$1
$3
$40
40%
25%
 
Edit
90-day supply
$3
$9
$120
40%
25%
Mail-Order
 
Edit
30-day supply
$1
$3
$40
40%
25%
 
Edit
90-day supply
$3
$9
$120
40%
25%
Standard Pharmacy Cost-Sharing
Pharmacy option
Edit
.
Tier 1: Preferred Generic
Tier 2: Generic
Tier 3: Preferred Brand
Tier 4: Non-Preferred Drug
Tier 5: Specialty
Retail – Standard Pharmacy
 
Edit
30-day supply
$10
$20
$47
50%
25%
 
Edit
90-day supply
$30
$60
$141
50%
25%
Mail-Order
 
Edit
30-day supply
$10
$20
$47
50%
25%
 
Edit
90-day supply
$30
$60
$141
50%
25%
Summary of Benefits
Evidence of Coverage
LIS Premium Chart
Pharmacy Directory
Formulary
Multi-languages Interpreter Services
Notice of Non-Discrimination
Enrollment Form
Pre-Enrollment Checklist
Star Rating
Clear Spring Health
Premier Rx
Monthly Premium

$24.00

Contract Number:

S6946-030 – 058

Pharmacy option

.
Tier 1: Preferred Generic
Tier 2: Generic
Tier 3: Preferred Brand
Tier 4: Non-Preferred Drug
Tier 5: Specialty

Retail

30-day supply
$1
$3
$40
40%
25%

90-day supply
$3
$9
$120
40%
25%

Mail Order

30-day supply
$1
$3
$40
40%
25%

90-day supply
$3
$9
$120
40%
25%

Covered Drug

Plan: S5617-293-000

Limitations, copayments, and restrictions may apply. See above or contact the plan for more details.

*Enrollee must continue to pay the Medicare Part B premium.

** Most plans have mail order savings with $0 copay for Tier 1 drugs for a 90-day supply which, if used, may result in lower costs than displayed.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1 (800) 633-4227). TTY users should call 1 (877) 486-2048. 24 hours a day, 7 days a week.

The Social Security Office at 1 (800) 772-1213. TTY users should call 1 (800) 325-0778. Monday through Friday, 7 a.m. to 7 p.m.

Your State Medicaid Office.

Enroll Today!