Provider Pharmacy Resources

Pharmacy Resources

CarePlus Drug List

Access prescription drug guides and Part D utilization management requirements by visiting the CarePlus Prescription Drug Information page.

Part D Coverage Determinations

Find out how to request a coverage determination for a Part D prescription drug and how to access coverage determination request forms.

PDFHow to Request a Coverage Determination or an Exception (PDF opens in new window) 

PDFPrescription Drug Coverage Determination Request Form (PDF opens in new window) 

If you prefer, you can complete the Coverage Determination Request (link opens in new window) . Before completing the online request, you may want to view our accepted file types (link opens in new window) .

You also can access the Medicare Coverage Determination Request Form at the following CMS Part D webpage link: Part D Coverage Determination Request Form (link opens in new window) .

Medication Therapy Management (MTM) Program

To learn how we help MTM-eligible CarePlus members better understand their medications, please visit our MTM Program page.

Part B Step Therapy Preferred Drug List

In August 2018, the Centers for Medicare & Medicaid Services (CMS) rescinded its September 2012 memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services.” CMS now allows Medicare Advantage plans to apply step therapy for physician-administered and other Part B drugs.

Step therapy is a type of pre-authorization for drugs that require patients to initiate treatment for a medical condition with the most preferred drug therapy. Patients then progress to other therapies only if necessary.

Due to the 2018 change, CarePlus will require a review of some injectable drugs and biologics for step therapy requirements in addition to current review requirements. The affected drugs/devices are indicated on the PDFPart B Step Therapy Preferred Drug List (PDF opens in new window).

Transition Policy

CarePlus works to ensure continuous provision of necessary drugs to members during a transition period.

PDFPart D Prescription Drug Plan Transition Policy for Providers (PDF opens in new window) 

Pharmacy Manual

The CarePlus Pharmacy Manual may assist providers in coordinating healthcare for patients with CarePlus plans.

PDFCarePlus Pharmacy Manual (PDF opens in new window)