Part D Pharmacy Benefits

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Prevea360 Medicare Advantage Advantage Plans

Medications can play a significant role in your health care. The following information will help guide your decisions about medications and answer questions about your Medicare pharmacy benefits.
 
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1-800-772-1213 between 7am and 7pm, Monday through Friday. TTY users should call 1-800-325-0778; or
  • Your State Medicaid Office



Formulary (List of covered drugs)

View a listing of covered medications in our comprehensive formulary.

Utilization Management for Prescription Drugs
Some covered medications have additional requirements, such as a prior authorization requirement or limits on coverage. See requirements and access Prevea360 Medicare Advantage prior authorization forms.  


Part D Coverage Determinations, Exceptions, Appeals and Grievances

Read more about Part D coverage determinations, exceptions, appeals and grievances.  


Pharmacy Benefit Guideline FAQ

Read some common questions and answers on Medicare pharmacy (Part D) topics.
 

Pharmacy Transition Process

Learn about our pharmacy transition process for prescription drug coverage when you are a new member to plan, a returning member, when you change locations of care, and other special circumstances.
 

Find a Pharmacy

Search for nationwide pharmacy providers available through Prevea360 Medicare Advantage plans. And learn about using out-of-network pharmacies.
 

Vaccine Coverage

Read about how some vaccines are covered under the Part D benefit and when vaccines are covered under Medicare Part B.
 

Medication Therapy Management Program

Read about our Medication Therapy Management Program.
 

Drug Overutilization Review Program

Learn about how we meet the CMS requirement to prevent clinically inappropriate overuse of opioid medicines and acetaminophen.
 

You can contact Member Services if you need additional information, including:

  • How we control the use of services and costs
  • The number of appeals and grievances filed by our members
  • A summary description of how we pay our doctors
  • A description of our financial condition, including a summary of our most recent audit statement