Memorial Hermann Health Plan is excited to offer a Dual Special Needs Plan (D-SNP) called Memorial Hermann Dual Advantage (HMO D-SNP) for 2024. A dual special needs plan is a type of health insurance plan for people that meet eligibility criteria and have both Medicaid and Medicare coverage. You may see this referred to as “dual-eligible” or a D-SNP plan. These names all mean the same thing.
Dual health plans work together with your Medicaid coverage. You’ll keep all your Medicaid benefits. Dual health plans cover eligible prescription drugs and may offer more health benefits than with Original Medicare and a separate Part D plan. For more specific information on if you are eligible for a D-SNP plan or would like to learn more about this plan, please call Customer Service at (855) 645-8448 (TTY 711) for assistance. Hours of operation are 7 days a week from 8 a.m. to 8 p.m. CT, during October 1 – March 31 and Monday – Friday from 8 a.m. to 8 p.m. CT, during April 1 – September 30.
Formulary
Every plan has a "List of Covered Drugs" which are also known as a Formulary or a Drug List (or also known as Prescription Drug Lists or PDL). The Prescription Drug List (PDL) or Formulary is updated at least monthly and can vary from plan to plan. To view more information on what is a Prescription Drug List (PDL) or Formulary, please visit the formulary information page.
Memorial Hermann Dual Advantage (HMO D-SNP) members may also request to receive a printed Formulary in the mail. Please click here to complete the request form.
List of Medications with Prior Authorizations and Step Therapy Requirements
Some drugs on the Prescription Drug Lists (PDL) or Formulary may have additional rules associated with coverage or may have certain limitations. These limits are listed in the formulary documents above. You can also view the documents that explain our prior authorization and step therapy restrictions by visiting our formulary page. If you like to get more information or assistance with any drugs on the formulary, a drug with any limitations or coverage rules, or would like to get a drug that is not listed on the formulary, then please call Customer Service. Our contact information is listed on the formulary documents and on the bottom of this webpage.
D-SNP Pharmacy Directory
The pharmacy directory or network describes where you can get your medications. As a Memorial Hermann Dual Advantage (HMO D-SNP) member, you have access to a wide network of pharmacies that we are contracted with to provide your prescription coverage. You may use our online pharmacy search tool to find a pharmacy near you.
2024 Pharmacy Directory Listing
You can also view the entire list of all pharmacies here:
2024 D-SNP Pharmacy Directory
You may also get additional information including our preferred pharmacies and forms for mail order or home delivery by visiting our Pharmacy Directory page.
D-SNP Over-The-Counter (OTC) Benefit
Your Memorial Hermann Dual Advantage (HMO D-SNP) membership gives you up to $200 worth of healthcare products every quarter. You may use this benefit for any prescription items that are over the counter or any products that is listed on the catalogue that you may need. To learn more about your benefits and to view how to order, please visit the OTC Benefit page. For additional questions on your benefits or concerns regarding services, please call the Memorial Hermann Health Plan Customer Service department at (855) 645-8448 (TTY 711) for assistance.
Transition Policy
New members in our Plan may be taking drugs that aren’t on our formulary or that are subject to certain restrictions, such as prior authorization or step therapy. Current members may also be affected by changes in our formulary from one year to the next. The transition policy allows you to get a temporary supply of the non- formulary drug or drugs that have restrictions, if those members need a refill for the drug during the first 90 days of new membership in our Plan.
To learn more about our transition policy and how your medications are covered, please visit our Transition Policy page. Please note that our transition policy applies only to those drugs that are “Part D drugs” and bought at a network pharmacy.
Medication Therapy Management (MTM) Program
As a member of the Memorial Hermann Health plan, you are entitled to receive a Comprehensive Medication Review (CMR) through the Medication Therapy Management (MTM) Program. We have partnered with Navitus Health Solutions’ Clinical Engagement Center to provide this service. This service is available at no extra cost to you. This is a convenient way to take control of your health care needs — all within the comfort of your own home!
Navitus pharmacists can:
- Help lower the risk of prescription drug-related problems
- Offer tips on how to take your medications
- Manage your out-of-pocket expenses
To learn more about our MTM program and how you can qualify for this service, visit our MTM page or call Customer Service at (855) 645-8448 (TTY 711) for assistance.
Drug Management Program (DMP)
Drug Management Program (DMP) is a program that can help make sure you are safely using your prescription opioid medications or benzodiazepine medications. We work with your doctors to make sure your medications are appropriate and medically necessary. For more information on our DMP program, please read the Evidence of Coverage (EOC) Chapter 5, Section 10.2. You can also read more in the DMP page and contact our Customer Service Department for assistance.
Additional Plan Resources
Drug Coverage Determination Request
To learn more about drug coverage and how to get your medications covered through our plan, please view the information here.
How to Appeal a Coverage Decision
If we make a coverage determination or decision that you are not satisfied with, you can “appeal” the decision. It is asking us to review the decision and give you or your doctor an additional opportunity to submit additional information to support your request. Learn more about appeals here.
Complaints and Grievances
If you have a complaint or a grievance regarding the quality of your care or other services from the plan, you or your appointed representative can file a grievance. To learn more about this process and how to file a grievance, please visit the “Filing a Grievance” section.
Extra Help and LIS
You can get extra help in paying for your medications and to lower your costs. To learn more about how to qualify, learn about our LIS premium chart or to get more information, visit the Extra Help page.
Where to get more prescription coverage or pharmacy forms
The pharmacy resources page contains all Part D and prescription coverage related documents including home delivery or mail order forms, direct member reimbursement (DMR) forms, and more.
Where to get additional Plan documents
Additional plan documents including the enrollment forms, summary of benefits, evidence of coverage (EOC), medical power of attorney and more can be found at the plan Resource Center.
Additional Questions or Concerns
Do you have questions, concerns, need more information or documents? Call our Customer Service department at (855) 645-8448 (TTY 711) to learn more about your plan benefits, available resources and member services. Hours of operation are 7 days a week from 8 a.m. to 8 p.m. CT, during October 1 – March 31 and Monday – Friday from 8 a.m. to 8 p.m. CT, during April 1 – September 30.