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
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September 2023
Last updated: 08/31/2023
Prior Authorization Requirements
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September 2023
Last updated: 08/31/2023
Medicare Part D Opioid Policies
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Opioid Pharmacist Tip Sheet
Last updated: 11/25/2020
Forms
Opioid Prior Authorization Request Form
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Request Form
Last updated: 11/25/2020
Prescription Mail-Order Form/Brochure
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English
Last updated: 10/19/2021
Request for Medicare Prescription Coverage Determination Form
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Determination Form
Last updated: 03/31/2023
Request for Medicare Prescription Coverage Redetermination Form
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Redetermination Form
Last updated: 11/15/2020