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Information for

  • 2019
  • 2020

Prescription Drug Coverage Summary

Plan Name Retail Prescription Drugs Mail Order Prescription Drugs (90-day supply)
Eon Deluxe (HMO SNP) For generic drugs (including brand drugs treated as generic), either:
$0 copay/ $1.25 copay/ $3.40 copay

For all other drugs, either:
$0 copay/ $3.80 copay/ $3.40 copay
For generic drugs (including brand drugs treated as generics), either: $0 copay/$1.20 copay/$2.95 copay
For all other drugs, either: $0 copay/$1.20
copay/$2.95 copay.
Eon Silver (HMO SNP) Tier 1: $4 (30-day), $8 (60-day), $12 (90-day)
Tier 2: $15 (30-day), $30 (60-day), $45 (90day)
Tier 3: $47 (30-day), $94 (60-day), $141 (90-day)
Tier 4: $100 (30-day), $200 (60-day), $300 (90-day)
Tier 5: 28%
Tier 6: $11 (30-day), $22 (60-day), $33 (90-day)
Tier 1: $8
Tier 2: 24
Tier 3: $100
Tier 4: $200
Tier 5: 28%
Tier 6: $22
Eon Select (HMO) Tier 1: $2 (30-day), $4 (60-day), $6 (90-day)
Tier 2: $10 (30-day), $20 (60-day), $30 (90day)
Tier 3: $45 (30-day), $90 (60-day), $135 (90-day)
Tier 4; $95 (30-day), $190 (60-day), $285 (90-day)
Tier 5: 28%
Tier 1: $4
Tier 2: $20
Tier 3: $90
Tier 4: $190
Tier 5: 28%
Eon Gold (PPO SNP) In-network:

Tier 1: $4 (30-day), $8 (60-day), $12 (90-day)
Tier 2: $15 (30-day), $30 (60-day), $45 (90day)
Tier 3: $47 (30-day), $94 (60-day), $141 (90-day)
Tier 4: $100 (30-day), $200 (60-day), $300 (90-day)
Tier 5: 28%
Tier 6: $11 (30-day), $22 (60-day), $33 (90-day)

Out-of-network:
Tier 1: $4 (30-day)
Tier 2: $15 (30-day)
Tier 3: $47(30-day)
Tier 4: $100 (30-day)
Tier 5: 28%(30-day)
Tier 6: $11 (30-day)
Tier 1: $8
Tier 2: 24
Tier 3: $100
Tier 4: $200
Tier 5: 28%
Tier 6: $22
Eon Choice (PPO) In-network:

Tier 1: $2 (30-day), $4 (60-day), $6 (90-day)
Tier 2: $10 (30-day), $20 (60-day), $30 (90day)
Tier 3: $45 (30-day), $90 (60-day), $135 (90-day)
Tier 4: $95 (30-day), $190 (60-day), $285 (90-day)
Tier 5: 28%

Out-network:

Tier 1: $2 (30-day)
Tier 2: $10 (30-day)
Tier 3: $45 (30-day)
Tier 4: $95 (30-day)
Tier 5: 28% (30-day)
Tier 1: $4
Tier 2: $20
Tier 3: $90
Tier 4: $190
Tier 5: 28%

Need Help Paying for your Prescription Drugs?

If you are in a program that helps pay for your drugs (“Extra Help”), the information about costs for Part D prescription drugs may not apply to you. Please review the LIS Summary Chart to learn about your drug costs. Many people are eligible and don’t even know it. To see if you qualify, please follow the instructions on your Evidence of Coverage.

Why choose generics?

Eon Health covers both brand-name drugs and generic drugs. Generic drugs have the same active ingredient as a brand name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand–name drugs.

You will notice the Eon Health formularies offer generic substitutions for brand-name drugs when possible. By choosing generics, you will still get effective, safe treatment, and you may save money.

Why choose Mail Order?

Eon Health offers Mail Order for some pharmacy drugs. Mail Order provides you the option of having a 90-day supply of applicable prescription drugs delivered directly to your home. No need to go to the pharmacy! Some medications can be automatically refilled as well! Generally, Mail Order may also save you money and help you with medication management and adherence.

There are many ways you can move your medications to home delivery. To select Mail Order for your prescriptions please complete the following steps:

  • 1. Download the OptumRx Mail-In Order Form
  • 2. Complete the form in its entirety
  • 3. Mail the completed order form with your new prescriptions* to the address below:

OptumRx
PO Box 2975
Mission, KN 66201

* Do not staple or tape prescriptions to the order form

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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.