Prescription Drug Coverage
Most CarePlus plans include prescription drug coverage. Use the resources below to learn which prescription drugs are covered by your CarePlus plan.
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CarePlus Prescription Drug Guides

2025 PDGs 2024 PDGs Pharmacy Coverage information

To see the prescription drugs that are included in our formulary, please refer to the comprehensive Prescription Drug Guides below. These guides are updated on our website monthly. Only the current formulary for each plan will display

South Florida

Tampa Area

Orlando Area

Daytona Area

Treasure Coast

Jacksonville Area

To see the 2025 prescription drugs that are included in our formulary, please refer to the comprehensive Prescription Drug Guides below. Only the current formulary for each plan will display

South Florida

Tampa Area

Orlando Area

Daytona Area

Treasure Coast

Jacksonville Area

Part D Prior Authorization and Step Therapy Criteria

Part B Step Therapy Preferred Drug List

The Centers for Medicare & Medicaid Services (CMS) now allows Medicare Advantage (MA) plans to apply step therapy for physician-administered and other Part B drugs.

Step therapy is a type of prior authorization for drugs that require patients to initiate treatment for a medical condition with the most preferred drug therapy. Patients then progress to other therapies only if necessary.

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

In order for us to cover certain drugs on our formulary, the following rules may apply. If one of these rules is applicable to your drug, you will see this noted in your Prescription Drug Guide.

English Guidelines on PA, ST, QL, and Exceptions

Spanish Guidelines on PA, ST, QL, and Exceptions

Prescription Drug Transition Policy

We know that plan or benefit changes  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 currently covered by your CarePlus Plan 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

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Last Updated:

10/31/2024

Want to see more CarePlus benefits?

Explore our full list of CarePlus Medicare Advantage plans available in your area.

1CareNeeds Plus (D-SNP): This plan is available to anyone receiving both Medicare and Medicaid: Qualified Medicare Beneficiaries (QMB/QMB+), Specified Low-Income Medicare Beneficiaries (SLMB/SLMB+), Qualifying Individuals (QI), Qualified Disabled and Working Individuals (QDWI) and other Full Benefit Dual Eligibles (FBDE). CareNeeds Plus (HMO D-SNP) is sponsored by CarePlus Health Plans, Inc. and the State of Florida, Agency for Health Care Administration.

2CareComplete (HMO C-SNP) and CareComplete Platinum (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.

3CareBreeze (HMO C-SNP) and CareBreeze Platinum (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of chronic lung disorders.

4CareOne Plus (HMO-POS): This plan covers certain out-of-network services for members while visiting Puerto Rico. Except in emergency or urgent situations, non-contracted providers may deny care.

5CareOne Platinum (HMO-POS): This plan covers certain services received from out-of-network providers in Brevard and Indian River counties in Florida. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received by non-contracted providers.

6CareComplete Platinum (HMO-POS C-SNP): This plan covers certain services received from out-of-network providers located within the plan's service area. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received by non-contracted providers. This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.

7CareBreeze Platinum (HMO-POS C-SNP): This plan covers certain services received from out-of-network providers located within the plan's service area. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received by non-contracted providers. This plan is available to anyone enrolled in Medicare with a diagnosis of chronic lung disorders.

8CareSalute (HMO-POS): This plan covers certain services received from out-of-network providers located within the plan's service area. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received by non-contracted providers.

CareNeeds Plus (HMO D-SNP): This plan is available to anyone receiving both Medicare and Medicaid: Qualified Medicare Beneficiaries (QMB/QMB+), Specified Low-Income Medicare Beneficiaries (SLMB/SLMB+), Qualifying Individuals (QI), Qualified Disabled and Working Individuals (QDWI) and other Full Benefit Dual Eligibles (FBDE).  

CareNeeds Platinum (HMO D-SNP): This plan is available to anyone receiving both Medicare and Medicaid: Qualified Medicare Beneficiaries (QMB/QMB+), Specified Low-Income Medicare Beneficiaries (SLMB/SLMB+), Qualifying Individuals (QI), Qualified Disabled and Working Individuals (QDWI) and other Full Benefit Dual Eligibles (FBDE).  

CareComplete (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.  

CareComplete Platinum (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.  

CareBreeze Platinum (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of chronic lung disorders. 

(057-CareOne Plus (HMO-POS): This plan covers certain out-of-network services for members while visiting Puerto Rico. Except in emergency or urgent situations, non-contracted providers may deny care. 

(001 CareOne Plus (HMO-POS); 043 CareOne Plus (HMO-POS); 135 CareFree Platinum Giveback (HMO-POS); 143 CareSalute (HMO-POS): This plan covers certain services received from out-of-network providers located within the plan's service area. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received by non-contracted providers. 

CareNeeds Plus (HMO D-SNP): Plan sa a disponib pou nenpòt moun ki resevwa avantaj Medicare ak Medicaid: Benefisyè Medicare ki Kalifye yo (QMB/QMB+, akwonim li an angle), Benefisyè Medicare ki Gen Revni Fèb yo Presize yo (SLMB/SLMB+, akwonim li an angle), Moun ki Kalifye yo (QI, akwonim li an angle), Moun ki Andikape epi ki Ap Travay ki Kalifye yo (QDWI, akwonim li an angle) ak lòt Kalifye an Doub pou Tout Avantaj yo (FBDE, akwonim li an angle).  

CareNeeds Platinum (HMO D-SNP): Plan sa a disponib pou nenpòt moun ki resevwa avantaj Medicare ak Medicaid: Benefisyè Medicare ki Kalifye yo (QMB/QMB+, akwonim li an angle), Benefisyè Medicare ki Gen Revni Fèb ki Espesifye yo (SLMB/SLMB+, akwonim li an angle), Moun ki Kalifye yo (QI, akwonim li an angle), Moun ki Andikape epi ki Ap Travay ki Kalifye yo (QDWI, akwonim li an angle) ak lòt Kalifye Doub pou Tout Avantaj yo (FBDE, akwonim li an angle).  

CareComplete (HMO C-SNP): Plan sa a disponib pou nenpòt moun ki enskri nan Medicare epi yo dekouvri ki fè dyabèt, maladi kadyovaskilè oswa ensifizans kadyak kwonik.  

CareComplete Platinum (HMO C-SNP): Plan sa a disponib pou nenpòt moun ki enskri nan Medicare yo dekouvri ki fè dyabèt, maladi kadyovaskilè, oswa ensifizans kè kwonik.  

CareBreeze Platinum (HMO C-SNP): Plan sa a disponib pou nenpòt moun ki enskri nan Medicare yo wè ki gen maladi nan poumon kwonik.