Dual-eligible health plans, also known as Dual Special Needs Plans (D-SNPs), are a type of Medicare Advantage plan for people who qualify for both Medicaid and Medicare. Dual health plans may tailor their drug formularies, benefits and provider choices to meet the specific needs of the members they serve.
People on Medicaid and Medicare tend to have serious, long-lasting health problems. They may also be on a number of prescription medicines. Certain prescriptions may not be on the list of Medicaid-approved drugs, drugs approved by Medicare or your health plan formulary. These prescriptions are considered non-formulary drugs.
If a prescription isn’t on your health plan’s formulary, you’d probably have to pay for it out of pocket. And paying for prescription drugs can be very expensive. That’s why it’s important to make sure any prescription medicines you need are listed on the drug formulary before you enroll or switch to a different health care plan.