CarePlus Prescription Drug Guides

To find out if your prescription drugs are covered, please refer to the 2023 and 2024 Comprehensive Prescription Drug Guides (also known as formularies).

Part D Utilization Management Requirements: Prior Authorization (PA), Step Therapy (ST), Quantity Limit (QL), and Exceptions

• English Guidelines on PA, ST, QL, and Exceptions
• Spanish Guidelines on PA, ST, QL, and Exceptions

Part D Prior Authorization and Step Therapy Criteria

• Prior Authorization Criteria
• Step Therapy Criteria

Prescription Drug Transition Policy

We know that changing plans can be confusing. CarePlus wants to make sure that you, as a new or existing member, safely transition into the new plan year. If you are not able to get your prescription drug because it is not in the current Prescription Drug Guide or it requires prior authorization because of quantity limits, step therapy requirements, or confirmation of your clinical history, we can help. To learn more about the transition process, please review our Transition Policy.

• Transition Policy – English
• Transition Policy – Spanish

How and Where to Send Your Request for Prescription Drug Payment

You can mail your request for prescription drug payment reimbursement along with any bills, receipts, and medical record documentation directly to us. To make sure you are giving us all the information we need to make a decision on your payment request, please fill out our Prescription Drug Claim Form provided below.  Using this form will help us process your request faster. You can also call Member Services.

• Prescription Drug Claim Form – English
• Prescription Drug Claim Form – Spanish

The Prescription Drug Claim Form or signed reimbursement request must be sent in writing.

Send the completed Prescription Drug Claim Form or signed reimbursement request to:

CarePlus Health Plans
Attention: Member Services Department
PO Box 277810, Miramar, FL 33027

Fax us at our toll-free fax number: 1-800-310-9071

You can also find detailed information about requesting a prescription drug payment reimbursement in Chapter 7, Section 2 of your Evidence of Coverage, which is titled “How to ask us to pay you back or to pay a bill you have received” 

You may review our Prescription Drug Direct Member Reimbursement Policy below:

• Part D Direct Member Reimbursement Policy – English
• Part D Direct Member Reimbursement Policy – Spanish

Interested in a CarePlus plan? Our licensed CarePlus sales agents are available to help you select the coverage that best meets your needs, including plans with enhanced insulin and vaccine benefits call 1-855-605-6171 (TTY: 711). 

Are you a current member? If you are a CarePlus member and have any questions about these enhanced benefits, please contact CarePlus Member Services at the number on the back of your Member ID card for more information.