Skip to main content

Pharmacy

Here you will find pharmacy-related information including the Medicare formulary as well as links to request or appeal drug coverage.

AcariaHealth Specialty Pharmacy
Available at no additional cost to patients undergoing treatment for long-term, life-threatening or rare conditions.

Express Scripts® Pharmacy Mail Service
Tell your patients about this convenient way to have maintenance medications delivered to their doorstep. Members can sign up at express-scripts.com/rx.

Coverage Determination 
Request coverage or exception for a prescription drug.

Medication Appeals 
Appeal a coverage determination decision.

Formulary
Use the Find My Plan tool to find the most up-to-date complete formulary.

Pharmacy Forms

This policy provides a list of drugs that require step therapy effective January 1, 2024. Step therapy is when we require the trial of a preferred therapeutic alternative prior to coverage of a non-preferred drug for a specific indication.

MCPB.ST.00: This policy provides a list of drugs that require step therapy.

Drug Prior Authorization Requests Supplied by the Physician/Facility

Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.

Fill out and submit this form to request an appeal for Medicare medications.

Contact Us icon

Need help? We're here for you.

Contact Us
Last Updated On: 9/27/2023
If you are impacted by the Change Healthcare outage, please¬†visit our website¬†for further information. ×