Formulary Preamble for Longevity Health Plan (HMO I-SNP)

Find a Drug

This pharmacy directory was updated on 12/17/2019. For more recent information or other questions, please contact Longevity Health Plan (HMO I-SNP) Member Services at 866-224-9499 or, for TTY users, 711, Hours of Operation: 8a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30, or visit LongevityHealthPlan.com.

Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at LongevityHealthPlan.com. You may also call Member Services for updated provider.

Introduction

This booklet provides a list of Longevity Health Plan (HMO I-SNP)’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Longevity Health Plan (HMO I-SNP)’s formulary.

We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Longevity Health Plan (HMO I-SNP) only if they are filled at a network pharmacy [or through our mail order pharmacy service]. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage.

All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of 12/17/2019. For the most current list, please contact us. Our contact information appears on the front and back cover pages.

If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact us.

Longevity Health Plan (HMO I-SNP) is a HMO with a Medicare contract. Enrollment in Longevity Health Plan (HMO I-SNP) depends on contract renewal.

This pharmacy directory was updated on 12/17/2019. For more recent information or other questions, please contact Longevity Health Plan (HMO I-SNP) Member Services at 866-224-9499 or, for TTY users, 711, Hours of Operation: 8a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30, or visit LongevityHealthPlan.com.

Non-Discrimination Notice

Longevity Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Longevity Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Longevity Health Plan:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreters
  • Written information in other formats (e.g., large print, audio, accessible electronic formats,
    Braille, other formats)

Provides free language services to people whose primary language is not English, such as:

  • Qualified interpreters
  • Information written in other languages

If you need these services, contact Longevity Health Plan’s Member Services at the contact information below.

If you believe that Longevity Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Longevity Health Plan, P.O. Box 5850, Glen Allen, VA 23058; (888) 808-8995; (TTY 711); fax: 800-335-0270; email: Compliance@longevityhealthplan.com.

You can file a grievance in person or by mail, fax, or e-mail. If you need help filing a grievance, the Longevity Health Plan Member Services is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services at the Office for Civil Rights Complaint Portal, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building Washington, DC 20201, 1-800-368-1019 TTY/TDD: 1-800-537-7637 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

Multi-Language Interpreter Services

Arabic

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 9499-224-866-1 (رقم هاتف الصم والبكم: 711).

Chinese
注意:如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-224-9499(TTY 711)。

French
ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-866-224-9499 (TTY 711).

Haitian Creole
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-224- 9499 (TTY 711).

German
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-866-224-9499 (TTY 711).

Italian

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-866-224-9499 (TTY 711).

Korean
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-866-224-9499 (TTY 711) 번으로 전화해 주십시오.

Polish
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-866-224-9499 (TTY 711).

Portuguese
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-866-224- 9499 (TTY 711).

Russian
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-866-224-9499 (телетайп 711).
H1644_2020MLIFL_C

Spanish
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1- 866-224-9499 (TTY 711).

Tagalog
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-866-224-9499 (TTY 711).

Thai
เรยี น: ถา้ คณุ พูดภาษาไทยคณุ สามารถใชบ้ รกิ ารชว่ ยเหลอื ทางภาษาไดฟ้ รี โทร 1-866-224-9499 (TTY 711).

Vietnamese
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-866-224- 9499 (TTY 711).