Pharmacy Resources

Drug Formulary

Your drug formulary lists all prescription drugs covered under your plan. Search online or download the PDF for your plan.

Pharmacy Directory

Use the directories below to locate an in-network retail pharmacy near you.

Mail Order Prescriptions

Get up to a 90-day supply of maintenance medications delivered to your home. Use the form below or manage refills through the Pharmacy Member Portal.

Part D Utilization Management

Some medications on our formulary have special rules including prior authorization, step therapy, and quantity limits. These programs help ensure safe and effective medication use.

Coverage Determinations & Exceptions

A coverage determination is a decision about whether a prescription drug is covered under your plan. If a drug you need is not covered or has restrictions, you may request an exception. Your doctor will need to provide a written explanation of the medical reasons.

Submit your request by:

• Online: Member Portal
• Pharmacy Help Desk: 866-693-4620
• Fax: 1-858-790-7100
• Mail: Attn: Clinical Services, 10181 Scripps Gateway Court, San Diego, CA 92131

For Part D appeals after a denied coverage determination, see our Appeals & Grievances page.

Medication Therapy Management

The MTM program is a free service for members with multiple chronic conditions and complex drug needs. It helps ensure your medications are working effectively together.

Low Income Subsidy (Extra Help)

If you qualify for Medicare's Extra Help program, you may pay less for your prescription drugs. The LIS Premium Table shows the reduced cost-sharing amounts for qualifying members.

Pharmacy Quick Tips

A few simple habits can help you get more from your pharmacy benefit and avoid surprises at the counter.

• Fill at an in-network pharmacy. Using a pharmacy outside your network usually means paying full price. Use the Pharmacy Finder above to confirm a pharmacy is in-network before you go.
• Ask about generic options. Generic drugs work the same as their brand-name counterparts but often cost significantly less. Ask your doctor or pharmacist if a generic is available for anything you're prescribed.
• Consider mail order for maintenance medications. If you take the same medication regularly, a 90-day mail-order supply can mean fewer trips to the pharmacy and, in some cases, lower cost-sharing. See the Mail Order Pharmacy section above for details.
• Check the formulary before you fill something new. Not all drugs are covered the same way, and some require prior authorization or step therapy. Review the Drug Formulary above, or call the Pharmacy Help Desk if you're not sure.
• Keep an updated medication list. Bring a current list of everything you take — including over-the-counter medications and supplements — to every doctor's appointment and pharmacy visit. This helps your care team catch potential interactions early.
• Don't skip doses to save money. If cost is making it hard to take a medication as prescribed, call Member Services or ask your pharmacist about lower-cost alternatives, Extra Help, or manufacturer savings programs before you cut back on your own.
• Refill early, not late. Most pharmacies allow refills a few days before you run out. Refilling early helps you avoid a gap in medication, especially around holidays or travel.

Questions about any of these tips? Call Member Services at 1-800-838-8271 (TTY: 711), or the Pharmacy Help Desk at 1-866-693-4620.