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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.

Requirements and Policies

Prescription Drug Transition Policy

Download PDF: English Spanish Chinese
Last updated: 11/15/2021

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 Spanish
Last updated: 06/22/2021

Request for Medicare Prescription Coverage Determination Form

Download PDF: Determination Form
Last updated: 02/05/2021

Request for Medicare Prescription Coverage Redetermination Form

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