CarePlus Prescription Drug Guides
To see the prescription drugs that are included in our formulary, please refer to the comprehensive Prescription Drug Guides below. These guides are updated on our website monthly. Only the current formulary for each plan will display
South Florida
- CareOne Plus (HMO POS) (001)
- CareFree Giveback (HMO) (065)
- Carefree Platinum Giveback (HMO POS) (135)
- CareComplete Platinum (HMO C-SNP) (130)
- CareBreeze Platinum (HMO C-SNP) (124)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Platinum (HMO D-SNP) (023)
- CareAccess (HMO) (148)
- CareOne Plus (HMO) (006)
- CareFree Giveback (HMO) (076)
- Carefree Platinum Giveback (HMO) (136)
- CareComplete Platinum (HMO C-SNP) (121)
- CareBreeze Platinum (HMO C-SNP) (123)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Platinum (HMO D-SNP) (023)
- CareAccess (HMO) (148)
- CareOne Plus (HMO POS) (001)
- CareFree Giveback (HMO) (065)
- Carefree Platinum Giveback (HMO POS) (135)
- CareComplete Platinum (HMO C-SNP) (130)
- CareBreeze Platinum (HMO C-SNP) (124)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Platinum (HMO D-SNP) (023)
- CareAccess (HMO) (148)
Tampa Area
- CareOne Plus (HMO) (103-002)
- CareFree Giveback (HMO) (104-002)
- CareComplete Platinum (HMO C-SNP) (147-002)
- CareBreeze Platinum (HMO C-SNP) (151-002)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Plus (HMO D-SNP) (073)
- CareNeeds Platinum (HMO D-SNP) (146)
- CareAccess (HMO) (144)
- CareOne Plus (HMO) (103-001)
- CareFree Giveback (HMO) (104-001)
- CareComplete Platinum (HMO C-SNP) (147-002)
- CareBreeze Platinum (HMO C-SNP) (151-002)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Plus (HMO D-SNP) (073)
- CareNeeds Platinum (HMO D-SNP) (146)
- CareAccess (HMO) (144)
Orlando Area
- CareOne Plus (HMO POS) (057)
- CareFree Giveback (HMO) (149)
- Carefree Platinum Giveback (HMO) (138)
- CareComplete Platinum (HMO C-SNP) (147-001)
- CareBreeze Platinum (HMO C-SNP) (151-001)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Plus (HMO D-SNP) (073)
- CareNeeds Platinum (HMO D-SNP) (146)
- CareAccess (HMO) (144)
Daytona Area
- CareOne Plus (HMO) (098)
- Carefree Platinum Giveback (HMO) (140)
- CareComplete Platinum (HMO C-SNP) (108)
- CareBreeze Platinum (HMO C-SNP) (117)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Plus (HMO D-SNP) (073)
- CareNeeds Platinum (HMO D-SNP) (146)
- CareAccess (HMO) (144)
Treasure Coast
- CareOne Plus (HMO POS) (043)
- CareFree Giveback (HMO) (134)
- Carefree Platinum Giveback (HMO & HMO POS) (139)
- CareComplete Platinum (HMO C-SNP) (108)
- CareBreeze Platinum (HMO C-SNP) (117)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Plus (HMO D-SNP) (073)
- CareNeeds Platinum (HMO D-SNP) (146)
- CareAccess (HMO) (144)
Jacksonville Area
- CareOne Plus (HMO) (113)
- Carefree Platinum Giveback (HMO) (094)
- CareComplete Platinum (HMO C-SNP) (109)
- CareBreeze Platinum (HMO C-SNP) (118)
- CareComplete (HMO C-SNP) (150)
- CareNeeds Plus (HMO D-SNP) (073)
- CareNeeds Platinum (HMO D-SNP) (146)
- CareAccess (HMO) (144)
To see the 2025 prescription drugs that are included in our formulary, please refer to the comprehensive Prescription Drug Guides below. Only the current formulary for each plan will display
South Florida
CareOne Plus (HMO)
CareFree (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
CareOne Plus (HMO)
CareFree (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
CareOne Plus (HMO)
CareFree (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
Tampa Area
CareOne Plus (HMO)
CareFree (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum (HMO D-SNP)1
CareOne Plus (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum (HMO D-SNP)1
CareOne Plus (HMO)
CareFree (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
Orlando Area
CareOne Plus (HMO)4
CareFree (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
CareAccess (HMO)
CareOne Plus (HMO)4
CareFree (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
CareAccess (HMO)
Daytona Area
CareOne Plus (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
CareAccess (HMO)
Treasure Coast
CareOne Plus (HMO)
CareOne Platinum (HMO)5
CareFree (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum ((HMO D-SNP)1)
Jacksonville Area
CareOne Plus (HMO)
CareOne Platinum (HMO)
CareFree Platinum (HMO)
CareComplete Platinum (HMO C-SNP)2
CareBreeze Platinum (HMO C-SNP)3
CareNeeds Plus (HMO D-SNP)1
CareNeeds Platinum (HMO D-SNP)1
Part D Prior Authorization and Step Therapy Criteria
Part B Step Therapy Preferred Drug List
The Centers for Medicare & Medicaid Services (CMS) 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.
CarePlus will review some injectable drugs and biologics for step therapy requirements, in addition to current prior authorization review requirements. You can find a list of the drugs and biologics we will review, as well as alternatives to non-preferred drugs subject to step-therapy, here:
- English
Part B Step Therapy Preferred Drug List PDF opens in new window - Spanish
Part B Step Therapy Preferred Drug List PDF opens in new window
Part D Utilization Management Requirements: Prior Authorization (PA), Step Therapy (ST), Quantity Limit (QL), and Exceptions
In order for us to cover certain drugs on our formulary, the following rules may apply. If one of these rules is applicable to your drug, you will see this noted in your Prescription Drug Guide.
Part D Prior Authorization and Step Therapy Criteria
Prescription Drug Transition Policy
We know that plan or benefit changes 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 currently covered by your CarePlus Plan 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.
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 medical record documentation directly to us. To make sure you are giving us all the information we need to make a decision on your payment request, please fill out our Prescription Drug Claim Form provided below. Using this form will help us process your request faster. You can also
call Member Services
Prescription Drug Claim Form – English PDF opens in new window
Prescription Drug Claim Form – Spanish PDF 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 signed reimbursement request to:
CarePlus Health Plans
Attention: Member Services Department
P.O. Box 277810, Miramar, FL 33027 - Fax us at our toll-free fax number: 1-800-310-9071
- You can also find detailed information about requesting a prescription drug payment reimbursement in Chapter 7, Section 2 of your Evidence of Coverage, which is titled “How to ask us to pay you back or to pay a bill you have received”
- You may review our Prescription Drug Direct Member Reimbursement Policy below:
Part D Direct Member Reimbursement Policy – English PDF opens in new window
Part D Direct Member Reimbursement Policy – Spanish PDF opens in new window