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Effective January 31, 2020 at 11:59p.m. EST, the Centers for Medicare & Medicaid Services (CMS) imposed intermediate sanctions on Delaware Life Insurance Company. This means that Eon Health cannot accept new enrollments into our plan and/or market to enrollees at this time. Due to an increase in enrollment, we experienced significant enrollment issues.

While you may not have experienced this directly, the deficiencies cited by CMS include:

  • Failing to timely and accurately process enrollment requests
  • Failing to provide timely notices of acceptance or denials of enrollment requests
  • Failing to provide proof of coverage and other plan materials prior to member effective dates
  • Failing to correctly process requests for medical or drug coverage
  • Failing to provide information on a timely basis to current and prospective enrollees through the customer service call center.
  • Failure to provide proper oversight of the plan vendors

Eon Health is working diligently to resolve these issues as quickly as possible.

This does not impact your coverage with Eon Health. The benefits you have as a member of Eon Health continue while our plan is sanctioned. You still have access to our providers and pharmacy network and coverage for medical services and drugs on our formulary.

Can I make changes to my medical or prescription drug coverage?

If you believe you have been negatively impacted by the deficiencies stated above, you may qualify for a special election period that will allow you to enroll in a new plan now. To find out if you qualify for a special election period, please contact 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users should call 1-877-486-2048.

If you are eligible for a special election period, here are your options:

Option 1: Keep your current plan. If you are satisfied with your current coverage, you do not need to do anything to stay in our plan.

Option 2: You can switch to a different Medicare Prescription Drug Plan, Medicare Advantage Plan or other Medicare health plan, including a plan that offers prescription drug coverage. Your new coverage can start as early as the month after the new plan gets your application. Most Medicare health plans include prescription drug coverage, but not all. If you want Medicare prescription drug coverage, be sure to join a Medicare health plan that has this coverage or join a Medicare health plan that allows you to join a separate Medicare prescription drug plan.

What if I have more questions?

If you have any questions, please contact Eon Health at (855) 249-7811 Monday to Sunday 8am — 8pm from October 1 thru March 31 and Monday to Friday 8am — 8pm from April 1 thru September 30. TTY users should call 711.

Thank you for your continued membership with Eon Health.

Formulary Drug Search

Last updated on 04/01/2020

To see if your prescription is covered by our plan, please type in the name of the drug below. You may also search by tier to see a list of drugs per tier.

Formulary Drug List for the following plans:

Eon Select (HMO), Eon Choice (PPO)
Last Updated: 04/01/2020

Prior Authorization Criteria

Step Therapy Criteria

Quantity Limit Criteria

Search

Formulary Drug List for the following plans:

Eon Deluxe (HMO SNP)
Last Updated: 04/01/2020

Prior Authorization Criteria

Step Therapy Criteria

Quantity Limit Criteria

Search

Formulary Drug List for the following plans:

Eon Silver (HMO SNP), Eon Gold (PPO SNP)
Last Updated: 04/01/2020

Prior Authorization Criteria

Step Therapy Criteria

Quantity Limit Criteria

Search

* This drug may be covered under Medicare Part B or Part D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.

Mail order is available for formulary drugs that have a 90-day supply fill option.

Coverage Requirements

For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. This ensures our members use these drugs in a safe way. The types of additional requirements are listed below:

Prior Authorization – For certain drugs, your doctor will need to contact us before you can fill your prescription. Prior Authorization means that you or your provider will need to get approval from us before filling the prescriptions. If members don’t get approval, Eon Health may not cover the drug.

Quantity Limits – For certain drugs, our plan limits the amount of the drug that we will cover. For example, we provide 60 tablets per prescription per 30 days for metformin 1000 mg tablets. This may be in addition to a standard one-month or three-month supply.

Step Therapy – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed. For example, if Drug A and B both treat your medical condition, Eon Health may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Eon Health will then cover Drug B.

Formulary Changes

Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the current coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.

If we remove drugs from our formulary tool, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requires a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the FDA deems a drug on our formulary to be unsafe or the drug’s manufacturer removed the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

The following links provide information about updates that have been made to our plans’ formularies:

Notice to Formulary Changes

No formulary changes at this time.

Can I receive coverage for drugs not on the formulary?

Yes, if you believe you are entitled to payment or benefits on a certain drug, you can request a Coverage Determination. A coverage determination is a decision made by Eon Health regarding payment for a Part D drug or exceptions to our formulary. Please use the coverage determination request form below:

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Eon Health has a contract with Medicare to offer HMO and PPO Plans. Eon Health also has a contract with the Georgia Medicaid program and a contract with the South Carolina Medicaid program. Enrollment in Eon Health depends on contract renewal. Eon Deluxe (HMO SNP): This plan is available to anyone who has both Medicare and received assistance from the State. Eon Silver (HMO SNP) and Eon Gold (PPO SNP): These plans are available to anyone with Medicare who has been diagnosed with Cardiovascular Disorder, Chronic Heart Failure or Diabetes. Eon Health has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2022 based on a review of Eon Health’s Model of Care. This information is not a complete description of benefits. Contact the plan for more information. Limitations, Copayments, and restrictions may apply. Benefits, formulary, pharmacy/provider network, premium and cost sharing may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Premiums, co-pays/co-insurance may vary based on the level of Extra Help you receive. Please contact the plan for further details. Medicare beneficiaries may also enroll in Eon Health through the CMS Medicare Online Enrollment Center located at www.medicare.gov. The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary Eon Gold (PPO SNP) and Eon Choice (PPO),: Out of network/non-contracted providers are under no obligation to treat Eon Health members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask for a pre-service organization determination before you receive the service. Please call our customer service or see your Evidence of Coverage for more information, including cost-sharing that applies to out-of-network services.