Prescription support

Get extra help paying for your prescriptions (Low-Income Subsidy)

Contact any of the organizations below to see if you qualify for extra help paying for prescription drug premiums and costs.

Best Available Evidence (BAE) policy

If you think you qualify for the Low-Income Subsidy but your current information doesn't reflect that, you can request a review of your status on the Centers for Medicare & Medicaid (CMS) website.

About Best Available Evidence on CMS.gov

Give your medications a checkup

If you qualify, our Medication Therapy Management (MTM) program provides one-on-one consultation with a pharmacist to manage your medications.

Learn more about the MTM Program

Pharmacy documents + coverage levels

Part D coverage levels

See Part D coverage level details for the plans below

• 2024 Medica Advantage Value (PPO) NE/IA ($0 monthly premium)
• 2024 Medica Advantage Select (PPO) NE/IA ($26 monthly premium)
• 2024 Medica Advantage Preferred (PPO) NE/IA ($132 monthly premium)
• 2024 Medica Advantage Value (PPO) ND/SD ($0 monthly premium)
• 2024 Medica Advantage Select (PPO) ND/SD ($66 monthly premium)
• 2024 Medica Advantage Preferred (PPO) ND/SD ($192 monthly premium)

Prescription Claim Forms

Need reimbursement for covered Part D medications and vaccinations not submitted to your Part D coverage? Use the claim instructions and form below to get your prescriptions processed under your Part D coverage.

Medicare Part D Prescription Claim Form (PDF)

Reimbursement instructions for prescription (Part D) costs (PDF)

Drug list (formulary)

2024 Formulary (PDF)

Part B Drugs

For members who are new to therapy, we may require step therapy on some drugs covered under Medicare Part B.

View the list of Part B drugs that require step therapy