Provider Pharmacy Resources

Pharmacy Resources

News and Alerts

Read about pharmacy-related safety alerts, announcements and other medication-related information.

PDFChanges to 2022 Formularies (PDF opens in new window) 

PDFDrug recall notice for Hizentra (PDF opens in new window) 

PDFDrug recall notice for Chantix® (varenicline) tablets (PDF opens in new window) 

PDFDrug recall notice for Nature-Throid and WP Thyroid tablets (PDF opens in new window) 

PDFDrug recall notice for metformin extended-release tablets (PDF opens in new window) 

PDFDrug recall notice for NP Thyroid tablets (PDF opens in new window) 

PDFDrug recall notice for Natpara (PDF opens in new window) 

PDFInformation about Ivermectin Use (PDF opens in new window) 

PDFFormulary changes for Revlimid (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Breo Ellipta (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Flovent (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Restasis (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Dexilant (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Combigan (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Copaxone (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Durezol (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Mitigare (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Vascepa (PDF opens in new window) 

PDFNationwide prescription scam targeting healthcare providers (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Symbicort HFA inhaler (PDF opens in new window) 

PDFFAQ and Information about the launch of generic Afinitor (PDF opens in new window) 

PDFFAQ and Information About launch of Authorized Generic Insulin Aspart and Insulin Aspart Mix (PDF opens in new window) 

PDFImpact of ongoing angiotensin II receptor blocker (ARB) drug recalls (PDF opens in new window) 

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 requires patients to initiate treatment for a medical condition with the most preferred drug therapy. Patients then progress to other therapies, 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) 

“Medicare Prescription Drug Coverage and Your Rights” Standardized Pharmacy Notice (CMS-10147)

CMS requires network pharmacies to distribute the “Medicare Prescription Drug Coverage and Your Rights” notice to beneficiaries. This notice advises Medicare beneficiaries of their rights to contact their plans to obtain a coverage determination or request an exception if they disagree with the information provided by the pharmacist. This notice is provided to Medicare beneficiaries at the point of sale.

Follow the links below to access this notice in English and Spanish along with form instructions: