Text Size: Providence Medicare Advantage Plans (Medicare Part D) 2012 Pharmacy Resources
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Formulary (Drug List)
- 2012 Medicare Drug Formulary (PDF)
- Can the formulary change?
- 2012 Prior Authorization Criteria
- 2012 Part D Prior Authorization Criteria (PDF)
- 2012 Step Therapy Criteria
- 2012 Step Therapy Criteria (PDF)
- 2012 Quantity Limit Criteria
- Effective Generic Medications (PDF)
- Best Available Evidence - Centers for Medicare & Medicaid Services Web site
Pharmacy FAQs
- How do I find an in-network pharmacy in my area?
- Filling prescriptions outside of the network
- Member Pharmacy Transition Process
- Medication Therapy Management (MTM) Program
- How can I get diabetic meters and supplies?
If you have Part D questions or need more information please contact Customer Service.
Out-of-Network Pharmacies
In certain situations, prescriptions filled at an out-of-network pharmacy may also be covered. Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available.
Coverage Determination/Appeals and Grievances
You can contact customer service 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; or
- A description of our financial condition, including a summary of our most recent audit statement.
*We have 779 pharmacies available in our service area in addition to 22,000 pharmacies nationwide. Providence Medicare Advantage Plans has contracts with pharmacies that equal or exceed the Centers for Medicare and Medicaid (CMS) requirements for pharmacy access in your area.
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 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your State Medicaid Office.
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