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2010 Part D Pharmacy Coverage

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Current and Prospective Members
Current and Prospective members please call (866) 321-3947 for questions related to the America's 1st Choice Health Plans: 7 days - 8AM to 8PM EST from Nov 15th – Mar 1st Mon – Fri 8AM to 8PM EST from Mar 2nd – Nov 14th (TTY/TDD) - (800)735-8583 For questions related to your Medicare Part D Prescription Drug program please call (866)321-3947)



2010 Pharmacy Part D Coverage Information Pharmacy Network Information 2010 Formulary Information (List Of Covered Drugs) Drug Utilization Management & Quality Assurance What to do if you have a problem or complaint about getting a part d drug? Pharmacy Network Information To search for a pharmacy, click on the Pharmacy Network Listing link below. Type your county or pharmacy name in the “FIND” box then click on the “FIND NEXT” button. Pharmacy Network Listing Out of Network Policy 2010 Formulary Information (List Of Covered Drugs) To search for a drug, please click the link below. Once the document is opened, type your drug name or drug category in the “FIND” box then click on the “FIND NEXT” button. 2010 Formulary Click here for 2010 Formulary. Formulary Changes Formulary list may change during the year. Updates, if any, will be posted monthly. April 2010 July 2010 Prior Authorization Criteria Click here to learn which drugs require Prior Authorization. Click here to find the Provider Exception Request form. Step Therapy Criteria Click here to learn which drugs must meet Step Therapy Criteria. Drugs with Quantity Limits Click here to find out about drugs with Quantity Limits. Transition Policy What can you do if your drug is not on the Drug List? CMS Best Available Evidence Learn what can you do if you believe you are eligible for Low Income Subsidy but do not have a required piece of evidence. Low Income Subsidy (LIS) Information Learn how you may be able to get extra help with your prescription drug coverage. Grievance & Appeals Click here to make a complaint or request an appeal about a Part D drug. Drug Utilization Management & Quality Assurance Drug Utilization Management & Quality Assurance Medication Therapy Management What to do if you have a problem or complaint about getting a part d drug? Click here to learn more about how to ask for an Exception, a Coverage Determination an Appeal or to make a complaint. Coverage Determinations & Appeals, Grievances & Exceptions Coverage Determination/Tier Exception Request- Member Coverage Determination Request- Provider

Last Updated 06/14/2010
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America´s 1st Choice is a health Plan with a Medicare contract. Medicare approved Medicare Advantage Private Fee for Service plans available to anyone entitled to Part A and enrolled in Part B of Medicare through age or disability, not in ESRD, and in an approved service area. Enrollment period restrictions apply. Call the plan for details. You must continue to pay your Medicare applicable premiums if not otherwise paid for under Medicaid or by another third-party. Plans may be renewed annually. All plan types may not be available in all areas. Benefits vary by plan and counties.
H9720_Web_CMS__2010 CMS approval 1/15/10	© 2007 America's 1st Choice Health Plans, Inc. All Rights Reserved.