The following information, forms, and resources will assist you in understanding and managing your Part D prescription drug coverage.
If you would like to request a printed Formulary mailed to your home, please contact Customer Services at 775-982-3112.
Medication Management Therapy (MTM) Program Request for Coverage Determinations Part D Appeal Rights (Request for Redetermination of Prescription Denial) Medicare Best Available Evidence 90 Day Retail and Mail Order Information Transition Fills
2018 Formulary (English PDF) — October 2018
2018 Formulary (Spanish PDF) — October 2018
2018 Step Therapy Criteria (PDF) — October 2018
2018 Prior Authorization Criteria (PDF) — October 2018
2018 Part D Prescription Drug Transition Process — October 2018
Form to Request for Part D Prescription Drug Coverage Determination (PDF) — October 2018
Form to Request for Part D Prescription Drug Coverage Redetermination (PDF) — October 2018
Formulary Change Notice (PDF) — July 2018
Prescription Reimbursement Claim Form (PDF)
Personal Medication List (PDF)
2018 Network Pharmacies (English PDF) — October 2018
2018 Network Pharmacies (Spanish PDF) — October 2018
Material ID: Y0039_2019_SCPWebsite_M (CMS Accepted) Last Updated 10/08/2018
