Prescription support

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

Contact any of the organizations below to see if you qualify for extra help paying for prescription drug premiums and costs. Click on your state Medicaid office for contact information.

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 change in your status on the Centers for Medicare & Medicaid (CMS) website.

About BAE on CMS.gov

MTM: 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 about the MTM Program

Pharmacy documents + coverage levels

Part D coverage levels

To see details for your Part D coverage level, choose your plan:

Medica Advantage Solution H8889-001 (PPO)

2023 Medica Advantage Solution H8889-001 (PPO) ($85 monthly premium)
2024 Medica Advantage Solution H8889-001 (PPO) ($85 monthly premium)

Medica Advantage Solution H8889-002 (PPO)

2023 Medica Advantage Solution H8889-002 (PPO) ($95 monthly premium)
2024 Medica Advantage Solution H8889-002 (PPO) ($95 monthly premium)

Medica Advantage Solution H8889-003 (PPO)

2023 Medica Advantage Solution H8889-003 (PPO) ($196 monthly premium)
2024 Medica Advantage Solution H8889-003 (PPO) ($195 monthly premium)

Medica Advantage Solution H8889-004 (PPO)

2023 Medica Advantage Solution H8889-004 (PPO) ($134 monthly premium)
2024 Medica Advantage Solution H8889-004 (PPO) ($141 monthly premium)

Medica Advantage Solution H8889-005 (PPO)

2023 Medica Advantage Solution H8889-005 (PPO) ($0 monthly premium)
2024 Medica Advantage Solution H8889-005 (PPO) ($0 monthly premium)

Medica Advantage Solution H8889-008 (PPO)

2023 Medica Advantage Solution H8889-008 (PPO) ($19 monthly premium)
2024 Medica Advantage Solution H8889-008 (PPO) ($33 monthly premium)

Prescription claim forms

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

Medicare Part D prescription claim form (PDF)
Reimbursement instructions for prescription Part D costs (PDF)

Drug list (formulary)

• 2023 Formulary (PDF)
• 2024 Formulary (PDF)
• Search for a 2024 pharmacy

Part B drugs: Step therapy

We may require step therapy on some drugs covered under Medicare Part B, especially if you're new to therapy or treatment.

See Part B drugs that require step therapy