Aetna Medicare Rx Essentials
Aetna Website
Standard Form
2008 Aetna Medicare Comprehensive Formulary (.pdf)
2008 Aetna Formulary Search Tool
Directions:
Step 1: Click on Medicare Plans
Step 2: Choose Three Tier Open Formulary
Step 3: Click on “Medicare Medication Search”
Step 4: Begin Searching by Drug or Therapeutic Class
Prior Authorization Line: 1-800-414-2386
Customer Service: 1-800-529-5586
Members: 1-877-238-6211
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Cigna Medicare Rx (Plan One, Plan Two Enhanced)
Cigna Website
Cigna 2008 Formulary Search Tool (For .pdf versions of Plan One and Plan Two, follow links.)
Standard Forms
Coverage Determination Form
Prior Authorization: 1-800-558-9363
Customer Service: 1-800-735-1459
Members: 1-800-222-6700
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First Health Premier (First Health Premier Plan)
First Health Premier Website
Providers Website
2008
Premier Comprehensive Formulary(.pdf)
Formulary Search Tool
Forms:
Standard Form
Coverage Determination, Prior Authorization, Appeals and Grievance Procedures Forms
Prior Authorizations (Urgent Requests Only): 1-800-551-2694
Exceptions / Prior Authorizations Fax: 1-800-639-9158
Customer Service: 1-800-588-3322
Members: 1-866-865-0662
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Fox RX Care
Fox Rx Care Website
2008 Formulary (.pdf)
Medication Search Tool
Provider Information and Forms
Prior Authorization Forms
Customer Service: 1-866-369-7979
Prior Authorization Line: 1-877-369-9564
Prior Authorization Fax: 1-866-369-7978
Pharmacy Help Line: 1-800-364-6331
Customer Service/Members: 1-888-369-7979
(TTY/TTD) 1-866-369-7373
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Humana (Humana Standard)
Humana Website
2008 Humana
Formulary Search Tool
Forms:
Coverage Determination Form (CMS Standard)
Prior Authorization Form
Prior Authorization Line: 1-800-555-2546
Prior Authorization Fax: 1-877-486-2621
Appeals Line: 1-800-457-4708
Customer Service: 1-800-706-0872
Members: 1-800-281-6918
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Health Net (Orange Option 1 and 2)
HealthNet Website
Formularies:
Formulary Search Tool for Orange Option 1
Orange Option 2
(.pdf)
Drugs
Requiring Prior Authorization (.pdf)
Forms:
Prior Authorization Form
Coverage Determination Forms: There are no required forms for this procedure; Physicians can call the PA
line:
1-800-867-6564 to initiate.
Prior Authorization Line: 1-800-867-6564
Prior Authorization Fax: 1-800-977-8226
Override Requests: 1-800-693-8951
Customer Service/Members: 1-800-606-3604 or 1-800-949-0166
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Medco Medicare Prescription Plan (Value)
Medco Website
Exception forms
Formulary
Prior Authorization Line: 1-800-935-6103
Customer Service/Members: 1-800-758-4531
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Member Health (Community Care Rx)
Community Care Rx Website
Physician/Pharmacy Support Line: 1-866-684-5395 or TTY/TDD 1-866-684-5351 (Mon. – Sat. 7:00am to 10:30pm ET)
Formulary Search Tool
2008 CCRX Basic Plan Comprehensive
Formulary (.pdf)
Forms can be found by looking up the coverage of specific drugs under the search tool, by contacting
Legal Services for the Elderly 1-877-774-7772, or by calling the Community Care Rx Prior Authorization Line (below)
Exceptions/Prior Authorization Line : 1-866-316-6049
Appeals and Exceptions Fax: 1-866-868-0858
Customer Service/Members: 1-866-684-5353
(TTY/TTD) 1-866-864-5351
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Prescription Pathway (Bronze)
Prescription Pathway Website
Standard Forms
2008 Comprehensive Formulary and
Formulary Search Tool
Prior Authorization Line: 1-800-311-0594
Customer Service: 1-877-269-1151
Members: 1-800-766-3233
RxAmerica (Star Plan)
RxAmerica Website
2008 Comprehensive Star Plan Formulary (.pdf)
Standard Forms
Exceptions / Prior Authorization Line: 1-866-549-0991
Exceptions/Prior Authorization Fax: 1-866-855-2676
Customer Service: 1-877-279-0370
Members: 1-800-429-6686
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SilverScript
SilverScript Website
2008
Comprehensive Silverscript Formulary
Click on "Comprehensive Formulary" or "Drug List Look-Up" to search coverage of drugs
Coverage
Determination Form
Exceptions and Prior Authorizations: 1-800-294-5979
Exceptions Fax: 1-866-884-9475
Prior Authorization Line: 1-800-294-5979
Customer Service: 1-866-552-6106
Members: 1-866-235-5660
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Sterling Rx
Sterling Rx Website
2008 Comprehensive Formulary (.pdf)
Standard Form
Prior Authorization Line: 1-800-294-5979
Customer Service/Members: 1-866-552-6105
(TTY/TTD) 1-866-552-6288
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Unicare (Medicare Rx Rewards)
UniCare: MedicareRx Rewards Website
Formulary: Not posted on web. Providers must contact Unicare directly.
CMS Standard Form
Appeals and Exceptions Fax: 1-800-204-0015
Prior Authorization Line: 1-800-678-3784
Customer Service: 1-866-892-5334
Members: 1-800-928-6201
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United Healthcare: AARP Medicare Rx Plan (Preferred and Saver)
AARP Medicare Rx Plan Website
Look up drug coverage through the
Search
Tool
Formulary: Please use Search
Tool or contact Legal Services for the Elderly or AARP directly
Medication Prior Authorization Request Form
Prior Authorization Phone: 1-800-711-4555
Prior Authorization Fax: 1-800-527-0531
Customer Service: 1-866-255-4835
Members: 1-888-865-5575
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WellCare (Signature and Classic)
WellCare Website
Physician/Pharmacist Number: 1-866-800-6111 option 2, TTY/TDD 1-888-816-5252, Monday through Friday
7:00 a.m. – 10:30 p.m. EST
Formulary:
2008 WellCare Signature Comprehensive Formulary (.pdf)
2008 Classic Comprehensive Formulary (.pdf)
WellCare Formulary Search Tool
Coverage Determination
Form
Appeals Fax: 1-866-388-1766
Exceptions Fax: 1-866-388-1767
Phone Number for Expedited Appeals and Exceptions: 1-800-960-2530, extension 4002
Customer Service/Members: 1-888-547-5252
(TTY/TTD) 1-888-816-5252
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MaineCare Member Services: 1-800-977-6740
The MaineCare site has MaineCare/DEL
Formularies and Prior Authorization Forms (not Medicare Part D).
The CMS website has a
standard form for coverage determinations under Medicare Part D, together with
instructions for completing the form.
