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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.

CVS Caremark Mail Service Pharmacy 
Tell your patients about this convenient way to have maintenance medications delivered to their doorstep.

Coverage Determination 
Request coverage or exception for a prescription drug.

Medication Appeals 
Appeal a coverage determination decision.

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. 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.

Drug Prior Authorization Requests Supplied by the Physician/Facility

Point of Care Medicare Information for Providers

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: 4/11/2023