2019 CarePlus Prescription Drug Coverage Information

CarePlus offers prescription drug coverage in all of its plans. This coverage may vary depending on the plan selected. To find out if your prescription drugs are covered, please refer to the comprehensive formularies below, which are updated and posted on the website monthly. Only the current formulary will display.

The comprehensive formularies include a list of covered drugs selected by CarePlus. We worked with a team of doctors and pharmacists to make a formulary that represents the prescription drugs we think you need for a quality treatment program. CarePlus will generally cover the drugs listed in our formularies as long as the drug is medically necessary, the prescription is filled at a CarePlus network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

You may also request that a printed Prescription Drug Guide be mailed to you. Please fill out and submit this form or call Member Services at 1-800-794-5907; TTY: 711. From October 1 - March 31, we are open 7 days a week; 8 a.m. to 8 p.m. From April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m. You may always leave a voicemail after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day.

If you are not a CarePlus member, please fill out this form to request a Prescription Drug Guide be mailed to you.

Viewable Documents

Note: Our documents below are in Portable Document Format (PDF) and require Adobe Reader for viewing and printing. To get the plug-in, visit Adobe's Website to Download Adobe Reader(link opens in new window).

South Florida:

Part D Utilization Management Requirements: Prior Authorization (PA), Step Therapy (ST), Quantity Limit (QL), and Exceptions

Prescription Drug Transition Policy

We know that changing plans can be confusing. CarePlus wants to make sure that you, as a new or existing member, safely transition into the new plan year. If you are not able to get your prescription drug because it is not in the current Prescription Drug Guide or it requires prior authorization because of quantity limits, step therapy requirements, or confirmation of your clinical history, we can help. To learn more about the transition process, please review our Transition Policy.

PDF2019 Transition Policy-English (link opens in new window) 

PDF2019 Transition Policy-Spanish (link opens in new window) 

How and Where to Send your Request for Prescription Drug Payment

  • You can mail your request for prescription drug payment reimbursement along with any bills, receipts, and/or medical record documentation directly to us. To make sure you are giving us all the information we need to make a decision on your request for payment, you can fill out our Prescription Drug Claim Form provided below or call Member Services and ask for a form. Call 1-800-794-5907; TTY: 711. From October 1 - March 31, we are open 7 days a week; 8 a.m. to 8 p.m.. From April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m. You may always leave a voicemail after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day. Using this form will help us process the information faster.

    PDFPrescription Drug Claim Form - English (link opens in new window) 

    PDFPrescription Drug Claim Form - Spanish (link opens in new window) 

  • The Prescription Drug Claim Form or signed reimbursement request must be sent in writing.
  • Send the completed Prescription Drug Claim Form or written request to:

    CarePlus Health Plans, Inc.

    Attention: Member Services department

    11430 NW 20th Street, Suite 300

    Miami, FL 33172

    Fax us: Our Toll Free Fax number is 1-800-956-4288

  • You can also find detailed information about requesting a prescription drug payment reimbursement in CarePlus' Evidence of Coverage, under Chapter 7. Section 2.1 or by reviewing our Prescription Drug Direct Member Reimbursement Policy below.

    PDFPart D Direct Member Reimbursement Policy - English (link opens in new window) 

    PDFPart D Direct Member Reimbursement Policy - Spanish (link opens in new window)