Provider Information
- 2023 Provider Manual
- Participating Providers
- Participating Pharmacies
- Model of Care Training and Attestation
- 2023 Provider Quick Reference Guide
- Provider Information Update
Medical Information and Authorization
Pharmacy Information and Authorization
Formulary 2023
- 2023 Formulary (List of Covered Drugs)
(last updated 10/15/2022) - 2023 Formulary (List of Covered Drugs) (Spanish)
(last updated 10/15/2022) - 2023 Formulary (Prescription Drugs) Changes
(last updated 11/1/2023) - 2023 Formulary (Prescription Drugs) Changes (Spanish)
(last updated 11/1/2023) - 2023 Prior Authorization Criteria
(last updated 11/1/2023) - 2023 Step Therapy Criteria
(last updated 11/1/2023) - 2023 Formulary (Prescription Drugs) Search Tool
- Online Part D Coverage Determination/Redetermination
- 2023 Provider Coverage Determination Form
Member Benefit Information
- 2023 Summary of Benefits (English)
(contains multi-language insert) - 2023 Summary of Benefits (Spanish)
Page Last Updated: 10/31/2023