Prescription Drug Benefits
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 – April 2023: English/Spanish/Chinese
Last updated: 03/30/2023
Future Formulary Changes
Please check these formulary updates for upcoming changes in the drug coverage list.
Download PDF:
April 2023
Last updated: 03/30/2023
Requirements and Policies
Step Therapy Requirements
Download PDF:
April 2023
Last updated: 03/30/2023
Prior Authorization Requirements
Download PDF:
April 2023
Last updated: 03/30/2023
Prescription Drug Transitional Care Policy
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