Provider Information
- 2023 Provider Manual
- Participating Providers
- Participating Pharmacies
- Model of Care Training and Attestation
- Provider Quick Reference Guide (Pennsylvania Advantage Plan)
- Provider Quick Reference Guide (Pennsylvania Community Plan)
- Provider Information Update
- 2023 Provider Coverage Determination Form
Medical Information and Authorization
Pharmacy Information and Authorization
Formulary 2023
- 2023 Comprehensive Formulary (Prescription Drugs)
(last updated 9/1/2023) - 2023 Formulary (Prescription Drugs) Changes
(last updated 9/1/2023) - 2023 Prior Authorization Criteria
(last updated 9/1/2023) - 2023 Step Therapy Criteria
(last updated 9/1/2023) - 2023 Formulary (Prescription Drugs) Search Tool
- Online Part D Coverage Determination/Redetermination
Member Benefit Information
- 2023 Advantage Plan Summary of Benefits
(contains multi-language insert) - 2023 Community Plan Summary of Benefits
(contains multi-language insert)
Page Last Updated: 9/1/2023