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 PDF:
Plan Formulary – March 2023 – English/Spanish/Chinese
Last updated: 03/02/2023
Future Formulary Changes
Please check these formulary updates for upcoming changes in the drug coverage list.
Download PDF:
March 2023
Last updated: 03/02/2023
Requirements and Policies
Step Therapy Requirements
Download PDF:
March 2023
Last updated: 03/02/2023
Prior Authorization Requirements
Download PDF:
March 2023
Last updated: 03/02/2023
Medicare Part D Opioid Policies
Download PDF:
Opioid Pharmacist Tip Sheet
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: 02/05/2021
Request for Medicare Prescription Coverage Redetermination Form
Download PDF:
Redetermination Form
Last updated: 11/15/2020