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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.

약국 양식

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.

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Last Updated On: 9/27/2023
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