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Prescription Drug Forms

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

Last updated: 08/31/2023

Future Formulary Changes

Please check these formulary updates for upcoming changes in the drug coverage list.
Download PDF: September 2023
Last updated: 08/31/2023
Requirements and Policies

Step Therapy Requirements

Download PDF: September 2023
Last updated: 08/31/2023

Prior Authorization Requirements

Download PDF: September 2023
Last updated: 08/31/2023

Prescription Drug Transition Policy

Download PDF: English Spanish Chinese
Last updated: 06/07/2023

Medicare Part D Opioid Policies

Last updated: 11/25/2020
Forms

Opioid Prior Authorization Request Form

Download PDF: Request Form
Last updated: 11/25/2020

Prescription Mail-Order Form/Brochure

Download PDF: English
Last updated: 10/19/2021

Request for Medicare Prescription Coverage Determination Form

Download PDF: Determination Form
Last updated: 03/31/2023

Request for Medicare Prescription Coverage Redetermination Form

Download PDF: Redetermination Form
Last updated: 11/15/2020