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:
2023 Plan Formulary – October 2023 (English/Spanish/Chinese)
2024 Plan Formulary – January 2024 (English/Spanish/Chinese)
Last updated: October 1, 2023
Future Formulary Changes
Please check these formulary updates for upcoming changes in the drug coverage list.
Last updated: October 1, 2023
Requirements and Policies
Step Therapy Requirements
Last updated: October 1, 2023
Prior Authorization Requirements
Last updated: October 1, 2023
Prescription Drug Transition Policy
Medicare Part D Opioid Policies
Download PDF:
Opioid Pharmacist Tip Sheet
Last updated: November 25, 2020
Forms
Opioid Prior Authorization Request Form
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Request Form
Last updated: November 25, 2020
Prescription Mail-Order Form/Brochure
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English
Last updated: October 19, 2021
Request for Medicare Prescription Coverage Determination Form
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Determination Form
Last updated: March 31, 2023
Request for Medicare Prescription Coverage Redetermination Form
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Redetermination Form
Last updated: November 15, 2020