Provider Information
- 2019 Provider Manual
- Participating Providers
- Participating Pharmacies
- Model of Care Training and Attestation
- Provider Quick Reference Guide
Medical Information and Authorization
Pharmacy Information and Authorization
Formulary 2019
- 2019 Comprehensive Formulary (Prescription Drugs)
(Last Updated 11/2019) - 2019 Formulary (Prescription Drugs) Changes
(Last Updated 11/2019) - 2019 Prior Authorization Criteria
(Last Updated 11/2019) - 2019 Step Therapy Criteria
(Last Updated 11/2019) - 2019 Quantity Limits
(Last Updated 11/2019) - 2019 Formulary (Prescription Drugs) Search Tool
- Online Part D Coverage Determination/Redetermination
Formulary 2020
- 2020 Comprehensive Formulary (Prescription Drugs)
(Last Updated 11/2019) - 2020 Formulary (Prescription Drugs) Changes
(Last Updated 11/2019) - 2020 Prior Authorization Criteria
(Last Updated 11/2019) - 2020 Step Therapy Criteria
(Last Updated 11/2019) - 2020 Quantity Limits
(Last Updated 11/2019)
Member Benefit Information
- 2019 Summary of Benefits
(contains multi-language insert)
2020 Summary of Benefits
(contains multi-language insert)
