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 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 may 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 eligible members better understand their medications, please visit our MTM Program page.

Part B Step Therapy Preferred Drug List

In August of 2018, the Centers for Medicare & Medicaid Services (CMS) rescinded its September 2012 memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services,” and now allows Medicare Advantage (MA) plans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

Step therapy is a type of prior 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 this recent 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 makes arrangements to continue to provide necessary drugs to our members through a transition period. Read about our Part D transition policy.

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

Pharmacy Manual

CarePlus appreciates your participation and role in delivering quality pharmacy services to your CarePlus-covered patients. The CarePlus Pharmacy Manual is intended to assist pharmacy staff in processing claims for CarePlus plans.

PDFCarePlus Pharmacy Manual (PDF opens in new window)