Check out our catalog:
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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.
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CoverMyMeds
CarePlus partners with CoverMyMeds to provide real-time determinations for requests submitted online. You can access this service through the link below. Registration is required.
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CarePlus request forms
Complete the
Prescription Drug Coverage Determination Request Form
You also can complete the online Coverage Determination Request Form online in (
English orSpanish. )This is a general form that is not medication-specific. The CarePlus Pharmacy Utilization Management Unit may need to contact you for additional information before we can make a determination for the drug.
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CMS request form
Another option is to use the Centers for Medicare & Medicaid Services (CMS)
Coverage Determination Request Form.
Part B Step Therapy Preferred Drug List
Step therapy requires patients to start treatment with the most preferred medication for a condition before moving on to other options if necessary. CarePlus will require a review of some injectable drugs and biologics for step therapy requirements in addition to current review requirements. Refer to the Part B Step Therapy Preferred Drug list for details on affected drugs and devices.
CarePlus Drug List
Access prescription drug guides and Part D utilization management requirements by visiting the CarePlus Prescription Drug Information page.
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Medicare Drug Coverage and Your Rights
CMS mandates network pharmacies to provide beneficiaries with the “Medicare Prescription Drug Coverage and Your Rights” notice at the point of sale. This notice informs beneficiaries of their rights to contact their plans for coverage determinations or to request exceptions if they disagree with the pharmacist's information. Access this notice in
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Medication Therapy Management Program
Find out how we help MTM-eligible CarePlus members better understand their medications.
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CenterWell Pharmacy®
With CenterWell Pharmacy, CarePlus members can get their prescriptions delivered to their home, track their orders, and auto-refill their prescriptions.
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Medicare Prescription Payment Plan
Learn how the Medicare Prescription Payment Plan (MPPP) can help eligible CarePlus members with prescription payments.
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12/05/2025
