Prescription Drug Forms and Information

Prescription Drug Resources and Documents

Check below for important information about the Part D Transition Process, Prior Authorizations, the Step Therapy Criteria for Part-D Medicare, and the coverage determination and redetermination processes.

You can also find out more about Getting Extra Help with Your Prescription Drug Coverage.

Prescription Drug Resources

Online Drug Formulary

Drug Formulary PDF

Download: Plan Formulary – English/Spanish/Chinese

Requirements and Policies

Step Therapy Requirements

Download: Plan Step Therapy Requirements – January 2022

Prior Authorization Requirements

Download: Plan Prior Authorization – January 2022

Prescription Drug Transition Policy

Download: English Spanish Chinese

Medicare Part D Opioid Policies

Download: Opioid Pharmacist Tip Sheet

Forms

Opioid Prior Authorization Request Form

Download: Request Form

Prescription Mail Order Form/Brochure

Download: English Spanish

Request for Medicare Prescription Coverage Determination Form

Download: Determination Form

Request for Medicare Prescription Coverage Redetermination Form

Download: Redetermination Form