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
Drug Formulary PDF
Download:
Plan Formulary – English/Spanish/Chinese
Future Formulary Changes
Please check these formulary updates for upcoming changes in the drug coverage list.
Download:
Effective January 21
Requirements and Policies
Step Therapy Requirements
Prior Authorization Requirements
Download:
Plan Prior Authorization – January 2022
Medicare Part D Opioid Policies
Download:
Opioid Pharmacist Tip Sheet
Forms
Opioid Prior Authorization Request Form
Download:
Request Form
Request for Medicare Prescription Coverage Determination Form
Download:
Determination Form
Request for Medicare Prescription Coverage Redetermination Form
Download:
Redetermination Form