Coverage Limitations

Coverage Limitations


By law, certain types of drugs or categories of drugs are not covered by Medicare Drug Plans. These drugs or categories of drugs are called "exclusions" and include:

  • Nonprescription drugs, unless they are part of an approved step therapy
  • Drugs when used for anorexia, weight loss, or weight gain
  • Drugs when used to promote fertility
  • Drugs when used for cosmetic purposes or hair growth
  • Drugs when used for the symptomatic relief of cough or colds
  • Prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations
  • Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of sale
  • Barbiturates
  • Benzodiazepines

Contact Us

Questions? Call us at 1-800-777-4376 (TTY 1-800-947-3529) 24 hours-a-day, 7 days-a-week (office hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.).


Modified: 6/28/2017
 

Independent Care Health Plan (iCare) is a Medicare Advantage HMO SNP organization with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in any iCare plan depends on contract renewal. Plans are available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Part B premium is covered by the State if you are a full-dual member. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

  • H2237_IC1453 Approved
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • Customer Service: 1-800-777-4376
    • 24 hours-a-day, 7 days-a-week
    • (Office Hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.)
  • TTY: 1-800-947-3529
  • Fax: 414-231-1092
  • All content and images unless otherwise indicated are
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