Medications

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

Prescription Drug Copay Table

Download PDF: 2025 Copay Table (English) 2025 Copay Table (Spanish) 2025 Copay Table (Chinese)
Last updated: January 2, 2025

Drug Formulary PDF

Download PDF: Plan Formulary – January 2025: English/Spanish/Chinese
Last updated: December 24, 2024

Future Formulary Changes

Please check these formulary updates for upcoming changes in the drug coverage list.
Download PDF: October 2024
Last updated: October 29, 2024

Requirements and Policies

Step Therapy Requirements

Download PDF: January 2025
Last updated: December 24, 2024

Prior Authorization Requirements

Download PDF: January 2025
Last updated: December 24, 2024

Prescription Drug Transitional Care Policy

Download PDF: English Spanish Chinese
Last updated: June 7, 2023

Request for Medicare Prescription Coverage Determination Form

Download PDF: Determination Form
Last updated: May 9, 2024

Request for Medicare Prescription Coverage Redetermination Form

Download PDF: Redetermination Form
Last updated: January 7, 2025
Last updated 01/02/2025.