News and Alerts
Part D Coverage Determinations
Find out how to request a coverage determination for a Part D prescription drug and how to access coverage determination request forms.
CarePlus partners with CoverMyMeds to provide real-time determinations for requests submitted online. You can access this service through the link below, registration is required.
If you prefer, you can complete the Coverage Determination Request online in
You also can access the Medicare Coverage Determination Request Form at the following CMS Part D webpage link:
Part B Step Therapy Preferred Drug List
In August 2018, the Centers for Medicare & Medicaid Services (CMS) rescinded its September 2012 memo “Prohibition on Imposing Mandatory Step Therapy for Access to Part B Drugs and Services.” CMS now allows Medicare Advantage plans to apply step therapy for physician-administered and other Part B drugs.
Step therapy is a type of pre-authorization for drugs that requires patients to initiate treatment for a medical condition with the most preferred drug therapy. Patients then progress to other therapies, if necessary.
Due to the 2018 change, CarePlus will require a review of some injectable drugs and biologics for step therapy requirements in addition to current review requirements. The affected drugs/devices are indicated on the Part B Step Therapy Preferred Drug list below.
“Medicare Prescription Drug Coverage and Your Rights” Standardized Pharmacy Notice (CMS-10147)
CMS requires network pharmacies to distribute the “Medicare Prescription Drug Coverage and Your Rights” notice to beneficiaries. This notice advises Medicare beneficiaries of their rights to contact their plans to obtain a coverage determination or request an exception if they disagree with the information provided by the pharmacist. This notice is provided to Medicare beneficiaries at the point of sale.
Follow the links below to access this notice in English and Spanish along with form instructions:
