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Medicare Prescription Coverage

Learn About Your Coverage

Medicare Formulary
To Find Your Medications, Try Our Drug Search Tool
CDPHP Medicare Choices Drug Plans use a formulary, which is a list of covered drugs selected to meet patients' needs. Formularies are reviewed and updated on a regular basis by medical and pharmacy professionals. If the formulary changes, enrollees will be notified before the change takes effect.

Drugs on the formulary are organized into different tiers. Your copayment or coinsurance depends on which tier your drugs are in. Please note that generics are frequently the most cost-effective choice.

If you take a drug that is not on our formulary, you may ask us to cover that drug. Refer to the Evidence of Coverage (EOC) for details on the appeal process. Choose Medicare Choices HMO Plans and click the tab the corresponds to your plan. Then scroll down to the bottom of the page to view the EOC.

Sign Up for Our Mail-Order Service
Have your prescriptions filled and mailed directly to your home or office using the Caremark® mail-order pharmacy service. More information about this convenient option is available on the mail-order service tip sheet. Once you’re ready to sign up, complete and mail back the order form. The delivery timeframe for this service is 14 days.

Transition Policy
New members taking drugs that are not on our formulary or that are subject to certain restrictions, such as prior authorization or step therapy, should review the Transition Policy or the plan's Evidence of Coverage (EOC) for details. To view the EOC, choose Medicare Choices HMO Plans and click the tab that corresponds to your plan. Then scroll down to the bottom of the page. 

Resources

CDPHP® is a health plan with a Medicare contract. Enrollment in CDPHP Medicare Choices depends on contract renewal. To join, you must have Medicare Parts A and B and live in the service area.

CDPHP is an HMO with a Medicare contract. Enrollment in CDPHP Medicare Choices depends on contract renewal.

Y0019_18_3446 Approved Last Updated 11/22/2017