Prescription support

Extra help paying for your prescription (Low-Income Subsidy)

Find out if you qualify for extra help paying for your prescription drug premiums and costs by contacting any of the organizations below. Click on your state Medicaid office to find contact information.

Best available evidence policy

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

About best available evidence on CMS.gov

Give your medications a check-up

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

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

• 2024 Medica Advantage Solution H8889-001 (PPO) ($85 monthly premium)
• 2024 Medica Advantage Solution H8889-002 (PPO) ($95 monthly premium)
• 2024 Medica Advantage Solution H8889-003 (PPO) ($195 monthly premium)
• 2024 Medica Advantage Solution H8889-004 (PPO) ($141 monthly premium)
• 2024 Medica Advantage Solution H8889-005 (PPO) ($0 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 (Formularies)

2023 Formulary (PDF)

2024 Formulary (PDF)