Formulary and Drug Pricing Tool
Medicare Prescription Drug Plans
A formulary is a list of drugs selected by Care Improvement Plus in consultation with a team of health care
providers, which represents the prescription therapies believed to be a necessary part of a quality treatment
program. The formulary consists of both generic and brand name drugs.
Care Improvement Plus will generally cover the drugs listed in our formulary as long as the drug is medically
necessary, the prescription is filled at a Care Improvement Plus network pharmacy, and other plan rules are followed.
Click here to view the Care Improvement Plus online formulary.
If you would like a copy of the Drug List, call Member Services at 1-800-711-1656 (TTY: 711) 7 days a week, 8:00 am - 8:00 pm for more information.
Click on the link below to view the most current list of drugs covered on Care Improvement Plus’ formulary for the following plans: Gold Rx (PPO SNP), Gold Rx (Regional PPO SNP), Medicare Advantage (PPO), Medicare Advantage (Regional PPO).
2015 English Formulary
2015 Spanish Formuary
Click on the links below to view the most current list of drugs covered on Care Improvement Plus’ formulary for the following plans: Dual Advantage (PPO SNP), Dual Advantage (Regional PPO SNP), Silver Rx (PPO SNP), Silver Rx (Regional PPO SNP).
2015 English Formulary
2015 Spanish Formulary
Click on the links below to find out more information about the criteria for drugs that require a prior authorization, step therapy, or have a quantity limit.
Prior Authorization Criteria
Step Therapy Criteria
Ways to Save on Drug Costs
The Pharmacy Saver™ program was created to help members save money on many common prescription drugs. Hundreds of generic drugs now cost as low as $1.50. Simply use one of the participating pharmacies and show your member ID card.
Look up qualifying drugs, prices and participating pharmacies - United Pharmacy Saver
Upcoming Changes to Care Improvement Plus' Formulary
Care Improvement Plus may add or remove drugs from the formulary during the year. If we remove drugs from our formulary, add prior authorization(s), quantity limits and/or step therapy restriction(s) on a drug, and/or move a drug to a higher cost-sharing tier, we will notify you of the change at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, in which case we will immediately remove the drug from our formulary and notify you of the change.
For obtaining prescription drugs by mail, use one of the following
Pharmacy Mail Order Form (English)
Pharmacy Mail Order Form (Spanish)
Extra Help (Low Income Subsidy)
You may qualify for extra help paying your monthly drug plan premium and a portion of your prescription drug costs – and even prescription drug coverage through the coverage gap.
Extra help is provided by Medicare to pay prescription drug costs for people who meet specific income and resource limits. Resources include your savings and stocks, but not your home or car. If you qualify, you will get help paying for your Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. In most cases, if you get extra help, you won’t pay a premium. If you qualify for extra help, you won’t have a coverage gap either.
To see if you qualify, call: 1-800-MEDICARE (1-800-633-4227), TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Administration at 1-800-772-1213 between 7:00 am and 7:00 pm, Monday through Friday, TTY/TDD users should call 1-800-325-0778; or your State Medicaid Office.
Care Improvement Plus also contracts with Social Services Coordinators (SSC) who can help you find assistance with drug costs if you qualify. You can call SSC at 866-868-2155.
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
Part D Vaccine
If you have been prescribed a vaccine that is covered under Medicare and was administered by your physician, your physician may submit the claim to OptumRx for reimbursement and collect only your copay by submitting the Vaccine Claim form to:
P.O. Box 29046
Hot Springs, AR 71903
Upon receipt of the HCFA 1500 from the physician, OptumRx will process the paper claim and return reimbursement to the physician's office with an explanation of payment including the beneficiary's cost share for collection.
This page was last updated on: 12/31/2013 3:07:04 PM
- You can get additional information from the Centers for Medicare and Medicaid Services by calling 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), which is the national Medicare help line, 24 hours a day, 7 days a week.
- As a Care Improvement Plus member, you may request the aggregate number of Care Improvement Plus grievances, appeals and exceptions, by calling Member Services.