Limits on Our Medicare Prescription Coverages
For certain prescription drugs, MVP has additional requirements for coverage or limits on our coverage. These requirements and limits help us control drug plan costs and ensure that our members use these drugs in the most effective way. A team of doctors and pharmacists developed these requirements and limits for our health plans to help us provide quality coverage to our members.
Why Are Certain Drugs Not Covered?
Medicare rules do not allow Medicare Advantage plans to cover certain drugs, including:
- Drugs purchased outside of the United States
- Drugs used “off-label” (to treat conditions other than those the Food and Drug Administration has approved them to treat)
- Drugs used to treat erectile dysfunction or for cosmetic purposes
- Medications for cough or cold
- Vitamins and mineral products
For safety reasons and/or cost savings, certain drugs have limits on the amount that we will cover.
View the full list of medications with quantity limits for 2023 (PDF).
For safety reasons and/or cost savings, certain drugs need approval from us before you can fill them.
View the full list of medications that need prior authorizations for 2023 (PDF).
Coverage determinations let you ask us for exceptions to our policies about prescription drugs. Learn more about coverage determinations.
Other physicians/providers are available in the MVP Health Care network. MVP virtual care services through Gia are available at no cost-share for most members. 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. ©2023 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.
TruHearing® and (RE)TM are trademarks of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners. Retail pricing based on prices for comparable aids. Follow-up provider visits included for one year following hearing aid purchase. Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees. For questions regarding fees, contact a TruHearing hearing consultant.
Y0051_8263_M | Last Updated: 4/13/2023
Speak to a Representative
To shop for a plan, contact an MVP Medicare Advisor at 1-800-324-3899 (TTY 711)
For questions about your plan, contact the MVP Medicare Customer Care Center at 1-800-665-7924 (TTY 711). If you have an MVP DualAccess plan, call 1-866-954-1872 (TTY 711).
From April 1-September 30, reach us Monday-Friday, 8 am-8 pm.From October 1-March 31, reach us seven days a week, 8 am-8 pm.[No text in field]