Enroll Now

Members

HomeMembers > Medicare Part D
Couple

Medicare Part D

Medicare Prescription Drug (Part D) Resources & Links


 
Icon

Plan Premiums, Deductibles, and Cost Sharing

To find out more about our benefits, please click here to review our Summary of Benefits. The document highlights applicable premiums, co-payments, co-insurance, and deductibles. Please refer to the Evidence of Coverage for a complete explanation of our benefits.

Icon

Find a Pharmacy


Icon

Find a Drug


Icon

Out of Network Coverage

Information about Out of Network Coverage including limits and financial responsibility. English or Español

Icon

GRIEVANCE, COVERAGE DETERMINATION OR APPEAL

The process for coverage decisions and appeals can be found in Chapter 9 of your evidence of coverage (EOC). This is the process you use for issues such as whether something is covered or not and the way in which something is covered. Please refer to Chapter 9 of your EOC for a full description of the process. Evidence of Coverage

You can also access this information by downloading Chapter 9 here. English or Español

Icon

DRUG COVERAGE DETERMINATION FORM

File a Medicare Prescription Drug Coverage Determination Form Here.
Coverage Determination Request

Icon

REDETERMINATION REQUEST FORM

File a Redetermination Request Form Here.
Redetermination Request

Icon

PRIOR AUTHORIZATION REQUEST FORM


Icon

APPOINTMENT OF REPRESENTATIVE FORM

Appointment of Representative Form (AOR) - (CMS-1696).
Click here

Icon

MEDICATION THERAPY MANAGEMENT PROGRAM (MTMP)


Icon

TRANSITION PROCESS


Icon

Prior Authorization Criteria


Icon

Step Therapy Criteria


Icon

QUALITY ASSURANCE POLICY


Icon

LOW INCOME SUBSIDY (LIS) LEVELS