Employer-Based Medicare Advantage Plans

Drug Coverage

Our Medicare Advantage plans provide comprehensive prescription drug coverage with access to Medicare-approved drugs and benefits that offer more than the standard Part D coverage.

For a full list of generic and brand name drugs covered by MVP Employer Group Medicare Advantage plans (also known as a formulary), view the documents below.

MVP Formulary Documents

2025 Documents

• 2025 Medicare Part D Comprehensive formulary (PDF) (list of covered drugs) (updated 10/2024)

2024 Documents

• 2024 Medicare Part D Comprehensive formulary (PDF) (list of covered drugs) (updated 11/2024)
• Monthly Medicare Formulary Updates (PDF) (updated 11/2024)

$0 Preferred Generic Drugs

We cover many commonly used generic drugs at no cost. Tier 1 of the Formulary—Preferred Generic Drugs—includes select drugs to treat diabetes, blood pressure, bone health, and high cholesterol. Talk to your doctor to see if these drugs may be right for you. 

Drugs With Restrictions

For safety reasons and/or cost savings, certain prescription drugs have added requirements for coverage or limits on coverage. These requirements and limits ensure that members use these drugs in the most effective way and help control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for our health plans to help us provide quality coverage to our members. 

Quantity Limits

Certain drugs have limits on the quantity that can be covered. See a full list (PDF) of drugs with quantity limits for 2024 or see a full list (PDF) of drugs with quantity limits for 2025.

Prior Authorizations

Some drugs require approval, also known as prior authorization, from us before they can be filled. See a full list (PDF) of drugs require prior authorizations for 2024 or see a full list (PDF) of drugs require prior authorizations for 2025.

Step Therapy

Medicare Part D drugs that require step therapy. View the full list of medications that require step therapy for 2025 (PDF).

Learn More

You can learn more about your prescription drug coverage, including participating pharmacies and cost-saving mail-order prescriptions on our Medicare Part D page. 

MVP USA Care PPO™ Plan

If your employer offers USA Care, you have the freedom to see any provider in the U.S. who accepts Medicare for a fixed co-pay. You cannot be billed for any other amounts above your cost-sharing amount. 

 
USA Care works just like traditional health insurance. Simply show your MVP USA Care Member ID card at the doctor’s office. You may have a co-pay due at that time. 

 
To be eligible to provide care to a USA Care plan member, providers must be state-licensed and have a Medicare billing number, or be eligible to obtain one. Institutional providers treating USA Care members, such as hospitals and skilled nursing facilities, must contract with Medicare to treat Medicare beneficiaries. The Medicare program reports that over 90% of all health care providers accept Medicare payment. To find doctors, hospitals, and other providers who participate with Medicare, visit the website for Medicare. 

 
If your doctor or other health care provider would like more information about USA Care, they may call MVP Provider Services at 1-800-684-9286 (TTY 711). 

 
USA Care Provider Tip Sheet (PDF)  

MVP Health Plan, Inc. is an HMO-POS/PPO/HMO D-SNP organization with a Medicare contract and a contract with the New York State Medicaid program. Enrollment in MVP Health Plan depends on contract renewal. MVP Health Plan, Inc. has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 12/31/2024 based on review of MVP Health Plan’s Model of Care. Health benefit plans are issued by MVP Health Plan, Inc., an operating subsidiary of MVP Health Care, Inc. Not all plans available in all states and counties. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. For accommodations of persons with special needs at meetings, call 1-800-324-3899 (TTY 711).

Other physicians/providers are available in the MVP Health Care network. Gia virtual care services are available at no member cost-share for medical plans, including qualified high-deductible health plans (QHDHPs). Exceptions may apply for self-funded plans. In-person visits and referrals are subject to cost-share per plan. Members enrolled in a Medicare Rx plan without additional MVP medical coverage do not have access to MVP virtual care services through Gia. SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers On-Demand is a trademark of Tivity Health, Inc. ©2024 Tivity Health, Inc. All rights reserved. GetSetUp is a third-party provider and is not owned or operated by Tivity Health, Inc. (“Tivity”) or its affiliates. Users must have internet service to access online services. Internet service charges are responsibility of user.

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Last Updated: 10/1/2024