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Pharmacy Plan Coverage

Prescription Drug Tiers

2025 2024
Select Your Plan Year
2024 2025

Prescriptions / Prescription Drug Tiers

Prescription Drug Tiers for Medicare Advantage Plans

HealthTeam Advantage Medicare Advantage Plans cover everything Medicare Parts A and B cover. Plus our benefits cover all the other things you need including Prescriptions, Dental, Vision, Hearing, Fitness, and more.

Use our Medicare Plan Comparison Tool to Easily Explore Plans

Select Your Plan Year
2024 2025

HealthTeam Advantage Plan I (PPO)

Plan Details
  In-Network Retail
  Preferred Pharmacies Standard Pharmacies
 

Up to 30-Day Supply

Up to 100-Day Supply

Up to 30-Day Supply

Up to 100-Day Supply
Tier 1 – Preferred Generics $0 copay $0 copay $10 copay $25 copay
Tier 2 – Generics $5 copay $12.50 copay $20 copay $50 copay
Tier 3 – Preferred Brands $47 copay $117.50 copay $47 copay $117.50 copay
Tier 4 – Non-Preferred Drugs $100 copay $250 copay $100 copay $250 copay
Tier 5 – Specialty Drugs 33% coinsurance 33% coinsurance 33% coinsurance 33% coinsurance
  In-Network Mail-Order
  Up to 30-day supply Up to 100-day supply
Tier 1 – Preferred Generics $0 $0
Tier 2 – Generics $5 $12.50
Tier 3 – Preferred Brands $47 $117.50
Tier 4 – Non-Preferred Drugs $100 $250
Tier 5 – Specialty Drugs 33% 33%

HealthTeam Advantage Plan II (PPO)

Plan Details
  In-Network Retail
  Preferred Pharmacies Standard Pharmacies
 

Up to 30-Day Supply

Up to 100-Day Supply

Up to 30-Day Supply

Up to 100-Day Supply
Tier 1 – Preferred Generics $0 copay $0 copay $0 copay $0 copay
Tier 2 – Generics $0 copay $0 copay $12 copay $30 copay
Tier 3 – Preferred Brands $47 copay $117.50 copay $47 copay $117.50 copay
Tier 4 – Non-Preferred Drugs $100 copay $250 copay $100 copay $250 copay
Tier 5 – Specialty Drugs 33% coinsurance 33% coinsurance 33% coinsurance 33% coinsurance
  In-Network Mail-Order
  Up to 30-day supply Up to 100-day supply
Tier 1 – Preferred Generics $0 $0
Tier 2 – Generics $0 $0
Tier 3 – Preferred Brands $47 $117.50
Tier 4 – Non-Preferred Drugs $100 $250
Tier 5 – Specialty Drugs 33% 33%

HealthTeam Advantage Vitality Plan (PPO)

Plan Details
  In-Network Retail
  Preferred Pharmacies Standard Pharmacies
 

Up to 30-Day Supply

Up to 100-Day Supply

Up to 30-Day Supply

Up to 100-Day Supply
Tier 1 – Preferred Generics $0 copay $0 copay $10 copay $25 copay
Tier 2 – Generics $5 copay $12.50 copay $20 copay $50 copay
Tier 3 – Preferred Brands $47 copay $117.50 copay $47 copay $117.50 copay
Tier 4 – Non-Preferred Drugs 40% coinsurance 40% coinsurance 50% coinsurance 50% coinsurance
Tier 5 – Specialty Drugs 30% coinsurance 30% coinsurance 30% coinsurance 30% coinsurance
  In-Network Mail-Order
  Up to 30-day supply Up to 100-day supply
Tier 1 – Preferred Generics $0 $0
Tier 2 – Generics $5 $12.50
Tier 3 – Preferred Brands $47 $117.50
Tier 4 – Non-Preferred Drugs 40% 40%
Tier 5 – Specialty Drugs 30% 30%

HealthTeam Advantage Cardinal Plan (HMO)

Plan Details
  In-Network Retail
  Preferred Pharmacies Standard Pharmacies
 

Up to 30-Day Supply

Up to 100-Day Supply

Up to 30-Day Supply

Up to 100-Day Supply
Tier 1 – Preferred Generics $0 copay $0 copay $10 copay $25 copay
Tier 2 – Generics $5 copay $12.50 copay $20 copay $50 copay
Tier 3 – Preferred Brands $47 copay $117.50 copay $47 copay $117.50 copay
Tier 4 – Non-Preferred Drugs 40% coinsurance 40% coinsurance 50% coinsurance 50% coinsurance
Tier 5 – Specialty Drugs 33% coinsurance 33% coinsurance 33% coinsurance 33% coinsurance
  In-Network Mail-Order
  Up to 30-day supply Up to 100-day supply
Tier 1 – Preferred Generics $0 $0
Tier 2 – Generics $0 $0
Tier 3 – Preferred Brands $47 $117.50
Tier 4 – Non-Preferred Drugs 40% coinsurance 40% coinsurance
Tier 5 – Specialty Drugs 33% coinsurance 33% coinsurance

HealthTeam Advantage Diabetes & Heart Care Plan (HMO C-SNP)

Plan Details
  In-Network Retail
  Preferred Pharmacies Standard Pharmacies
 

Up to 30-Day Supply

Up to 100-Day Supply

Up to 30-Day Supply

Up to 100-Day Supply
Tier 1 – Preferred Generics $0 copay $0 copay $5 copay $12.50 copay
Tier 2 – Generics $0 copay $0 copay $15 copay $37.50 copay
Tier 3 – Preferred Brands $47 copay $117.50 copay $47 copay $117.50 copay
Tier 4 – Non-Preferred Drugs $100 copay $250 copay $100 copay $250 copay
Tier 5 – Specialty Drugs 31% coinsurance 31% coinsurance 31% coinsurance 31% coinsurance
Tier 6 – Select Care Drugs $0 $0 $0 $0
  In-Network Mail-Order
  Up to 30-day supply Up to 100-day supply
Tier 1 – Preferred Generics $0 $0
Tier 2 – Generics $0 $0
Tier 3 – Preferred Brands $47 $117.50
Tier 4 – Non-Preferred Drugs $100 $250
Tier 5 – Specialty Drugs 31% coinsurance 31% coinsurance
Tier 6 – Select Care Drugs $0 $0

Definition of the Six Drug Tiers

  • Tier 1 – Preferred Generics: Generic drugs that are available at the lowest cost share
  • Tier 2 – Generics: Generic and some very low-cost brand drugs that are available at a higher cost to you than drugs in Tier 1
  • Tier 3 – Preferred Brands: Generic or brand drugs that are available at a lower cost to you than drugs in Tier 4
  • Tier 4 – Non-Preferred Drugs: Generic or brand drugs that are available at a higher cost to you than drugs in Tier 3
  • Tier 5 – Specialty Drugs: This is the highest-cost tier. Some injectables and other high-cost drugs
  • Tier 6 – Select Care Drugs (only applies to CSNP plan): Generic or brand drugs that are used to treat or prevent conditions. Specifically, diabetes, cardiovascular disease and most vaccines.

Formulary

The Medicare program allows HealthTeam Advantage to make changes in our formulary at any time during the calendar year. A change in our formulary can affect which drugs are covered, the amount of copay, and limits on usage. If the plan makes any negative, non-maintenance formulary change, affected members will receive written notice that explains the change; the formulary on our website will also be updated.

For a list of changes made to the formulary, please see the formulary addendum available on the Plan Documents page.

VIEW PLAN DOCUMENTS >

Formulary Restrictions

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include prior authorization, step therapy, and quantity limits.

For more information on formulary restrictions, see the Formulary Restrictions page or review your Evidence of Coverage (EOC) document or Comprehensive Formulary available on the Plan Documents.

READ FORMULARY RESTRICTIONS >

Need More Assistance?

Extra Help for
Prescription Costs

You may be able to get extra help pay for your prescription drug premiums and costs. To see if you qualify, call or contact:

1-800-Medicare (1-800-633-4227, TTY: 1-877-486-2048) Call anytime.

The Social Security Office at (1-800-772-1213, TTY: 1-800-325-0778) Call between 7 a.m. and 7 p.m. ET Monday through Friday.

Visit North Carolina Medicaid Office online.

For more information about gap coverage or other prescription drug benefits, please see your Evidence of Coverage in Plan Documents.

Get Extra Help

Need to know more about Pharmacy and Drug Coverage with HealthTeam Advantage?

VIEW PHARMACY INFORMATION >

Corporate

300 E. Wendover Ave., Suite 121, Greensboro, NC 27401

Local Benefit Center

Walk-Ins Welcome

5815 Samet Dr., Suite 107, High Point, NC 27265

Didn’t find what you were looking for?

HealthTeam Advantage, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a PPO and HMO Medicare Advantage plan with a Medicare contract. 
Enrollment in HealthTeam Advantage depends on contract renewal.

Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Every year, Medicare evaluates plans based on a 5-star rating system.

Page last updated: October 01, 2024

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