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.
Requirements and Policies
Step Therapy Requirements
Prior Authorization Requirements
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