• English 2024 Enrollment Form
• Spanish 2024 Enrollment Form
• English Reimbursement Request Form
• Spanish Reimbursement Request Form
  
• English Dental Benefits Claim Form
• Spanish Dental Benefits Claim Form
• English Grievance or Appeal Request Form
• Spanish Grievance or Appeal Request Form
• English Request for Alternate Communications
• Spanish Request for Alternate Communications

• English 2024 CenterWell Pharmacy™ OTC Form
• Spanish 2024 CenterWell Pharmacy™ OTC Form
• English Part D Coverage Determination Request Form
• Spanish Part D Coverage Determination Request Form
• English Prescription Drug Claim Form
  
• Spanish Prescription Drug Claim Form
• Printable English Medication List
• Printable Spanish Medication List
• English Request for Redetermination of Medicare Prescription Drug Denial Form
• Spanish Request for Redetermination of Medicare Prescription Drug Denial Form

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
• Spanish Part B Step Therapy Preferred Drug List

• English Appointment of Representative Form
• Spanish Appointment of Representative Form
• English Consent for Release of PHI Form
• Spanish Consent for Release of PHI Form
• English Revocation of Consent for Release of PHI Form
• Spanish Revocation of Consent for Release of PHI Form
• English Request for Accounting of Disclosures
• Spanish Request for Accounting of Disclosures
• English Privacy Complaint Form
• Spanish Privacy Complaint Form