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Prescription Drug Coverage: Medicare Part D
Prescription Drug Coverage & Medication Management

Prescription Drug Coverage & Medication Management
(Highlights drug coverage by plan, prior approval guidelines, critical forms and other helpful information for healthcare providers and consumers)

Medicare Part D Plans Executive Summary

Medicare plans typically provide extensive information in regards to plan benefits. Prior authorization information and forms are readily available. In addition to tiered formularies, Medicare plans list which medications are included in Medicare Part B vs Part D. Additionally, Medicare formularies often have quantity limits listed within the formulary to limit the amount of drug that can be dispensed within a given time period. Formularies also have step therapy requirements in which some first line therapies be attempted before articular medications are approved. Mail order pharmacies are also available with many Medicare plans.

Plan Name Company Name Plan Type Formulary List Site / pdf Prior Authorization Criteria Site / pdf Prior Athorization Form Site / pdf Specific Forms by Drug Mail Order/ Specialty Pharmacy Other Helpful Links
AARP MedicareComplete United Healthcare PPO Link Link pdf No Specialty Pharmacy Drug List Tool
pdf
AARP MedicareRx Enhanced United Healthcare PDP pdf Link pdf No Mail Order Pharmacy Drug List Tool
AARP MedicareRx Preferred United Healthcare PDP pdf Link pdf No Mail Order Pharmacy Drug List Tool
AARP MedicareRX Saver Plus United HealthCare   pdf Link pdf No Mail Order Pharmacy Drug List Tool
Advantra Coventry Health Care HMO& PPO Link Link General pdf No Mail Order Form N/A
pdf Mail Order Pharmacy
Aetna CVS/Pharmacy  Aetna Medicare PDP Link Link pdf No N/A N/A
pdf
Aetna Medicare Rx Premier Aetna Medicare Rx Premier PDP Link Link pdf No N/A N/A
pdf
Aetna Medicare Open 3 Tier Aetna Medicare   pdf Link pdf No N/A N/A
Aetna Medicare Open 4 Tier w/Specialty Aetna Medicare   pdf Link pdf No N/A N/A
Aetna Medicare Open 5 Tier w/Specialty Aetna Medicare   pdf Link pdf No N/A N/A
Aetna Medicare Rx Essentials Aetna Medicare   Link Link pdf No N/A N/A
America's 1st Choice America's 1st Choice   Link Link pdf No Mail Order Pharmacy N/A
pdf
Blue Medicare Rx Enhanced BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA PDP pdf Link pdf No N/A N/A
Blue Medicare Rx Standard BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA PDP pdf Link pdf No N/A N/A
Blue Medicare HMO Standard BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA HMO pdf Link pdf No N/A N/A
Blue Medicare HMO/PPO Enhanced  BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA HMO/PPO pdf Link pdf No N/A N/A
Care Improvement Plus   pdf Link Link No N/A N/A
Care Improvement Plus SN   pdf Link Link No N/A N/A
Cigna HealthSpring Preferred/Preferred Plus   pdf Link pdf Yes N/A N/A
Cigna- HealthSpring Rx   pdf Link pdf Yes N/A N/A
CIGNA Medicare Rx Secure CIGNA Medicare Rx PDP Link Link pdf No Mail Order Pharmacy N/A
pdf
CIGNA Medicare Rx Secure-Max CIGNA Medicare Rx PDP Link Link pdf No N/A N/A
pdf
Cigna Medicare Rx Secure-Xtra Link Link pdf No N/A N/A
pdf
COEHA Medicare COEHA pdf Link pdf N/A N/A N/A
Express Scripts Medicare (Choice Plan) Express Scripts   Link Link Link No N/A N/A
pdf
Express Scripts Medicare (Value Plan) Express Scripts   pdf Link Link No N/A N/A
Express Scripts Medicare PDP   pdf Link Link No N/A N/A
Fidelis Secure Care Fidelis SecureCare of North Carolina Special Needs Link Link pdf Yes N/A N/A
pdf
First Health Essentials First Health Part D   Link Link pdf N/A N/A N/A
pdf
First Health Premier Plus First Health Part D PDP Link Link General pdf Yes N/A N/A
pdf Drug Specific pdf
First Health Value Plus First Health Part D PDP Link Link General pdf Yes N/A N/A
pdf
FirstMedicare Direct HMO/PPO     Link Link pdf No Mail Order Pharmacy N/A
pdf
HealthMarkets Value Rx     Link Link pdf No N/A N/A
pdf
Health Net Employer Group   pdf Link pdf Yes N/A N/A
Humana 5 Tier Plus   pdf Link pdf N/A N/A N/A
Humana National - 5   pdf Link pdf Yes N/A N/A
Humana National Special Needs     Link Link pdf Yes N/A N/A
pdf
Humana National Enhanced PDP Humana Insurance Company   Link Link pdf Yes N/A N/A
pdf
Humana Preferred Rx (Walmart) Humana Insurance Company   pdf Link pdf Yes N/A N/A
Humana Walmart RX Humana Insurance Company   pdf Link pdf Yes N/A N/A
Medicare Generation RX Employer PDP   pdf Link pdf N/A N/A N/A
MedicareRx Rewards Standard UniCare PDP Link Link pdf No N/A N/A
pdf
MedicareRx Rewards Plus (Unicare) UniCare PDP Link Link pdf No N/A N/A
pdf
NRECA Basic     Link Link pdf Mail Order Pharmacy N/A N/A
pdf
NRECA Basic Plus/Enhanced     Link Link pdf Mail Order Pharmacy N/A N/A
pdf
Prime Expanded Prime Therapeutics   pdf Link pdf Mail Order Pharmacy N/A N/A
Prime Ideal Prime Therapeutics   pdf Link pdf Mail Order Pharmacy N/A N/A
Prime Ideal Alternative Prime Therapeutics   pdf Link pdf Mail Order Pharmacy N/A N/A
Prime Ideal Defined Prime Therapeutics   pdf Link pdf Mail Order Pharmacy N/A N/A
Readers Digest Value Rx   N/A N/A N/A N/A N/A N/A
Silverscript Basic   pdf Link pdf No N/A N/A
Silverscript Plus   pdf Link pdf No N/A N/A
Silverscript Choice   pdf Link pdf No N/A N/A
Sterling Retireee PDP 3 Tier   pdf Link Link No N/A N/A
Sterling Retireee PDP 4 Tier   pdf Link Link No N/A N/A
Symphonix Rite Aid Value Rx   Link Link pdf No N/A N/A
TEAMstar Part D United American   pdf Link pdf Mail Order Pharmacy N/A N/A
Today's Options PFFS Universal American   Link Link pdf No N/A N/A
pdf
Today's Options PPO Universal American   pdf Link pdf No N/A N/A
Transamerica Medicare Rx Choice   pdf Link pdf Mail Order Pharmacy N/A N/A
Transamerica Medicare Rx Classic   pdf Link pdf Mail Order Pharmacy N/A N/A
UA Medicare Part D     Link Link pdf Mail Order Pharmacy N/A N/A
pdf
UnitedHealthcare MedicareComplete  United Healthcare SNP Link Link Specialty pdf Yes N/A N/A
pdf Online Prior Authorization
United MedicareRX  United HealthCare PFFS Link Link pdf No N/A N/A
pdf
Windsor Sterling Medicare Advantage   pdf Link pdf No N/A N/A
UPREHS Union Pacific   pdf Link pdf N/A N/A N/A
WellCare Classic WellCare PDP Link Link pdf No N/A N/A
pdf
WellCare Extra WellCare PDP Link Link pdf No N/A N/A
pdf

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