This Part D prescription drug information is for Partnership members who have both Medicare and Medicaid.

If you are not sure if you have Medicare and/or Medicaid, please ask your care team for help.

Formulary (List of Covered Drugs)  2023
The formulary explains what Part D prescription drugs are covered by the plan. It also tells you if there are any rules that limit coverage of a drug. Lastly, it includes the over-the-counter medications that are covered by Medicaid when ordered by a physician or nurse practitioner. 

Coverage Limits
Some covered drugs have limits or conditions for coverage.  The following documents explain the limits and conditions:

• Formulary Prior Authorization Criteria -  2023 
  Partnership must approve these drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
• Formulary Step Therapy Criteria  2023
  We require you to first try certain drugs to treat your medical condition before we will cover another drug for your condition.

Part D Formulary Transition Policy
The Part D Formulary Transition Policy tells you how we will help if your current prescription drug is not on the Community Care formulary or if it is taken off of the formulary after you have become a member.

Coverage Determination: To request a coverage determination please send us a secure email to ensure that information remains private. Send this secure email to [email protected] that includes:

• Member name and another member identifier (ID #, date of birth, etc.)
• Requestor (member or prescriber)
• Requestors contact information
• Medication requested
• Reason for request

Over the Counter (OTC) Program: You receive $35 a month. Over-the-counter medicine is also known as OTC or nonprescription medicine. This is medicine you can buy without a prescription. Your Community Care OTC benefit gives you a monthly credit of $35 to purchase over-the counter products from a list of approved items. This is an additional Medicare benefit provided by Community Care. You can use your credits to shop for vitamins, toothpaste, pain relief and more. The OTC benefit is included with your Community Care health plan at no cost to you. You will not have to pay for taxes or shipping. Authorization is not required.

Member Grievances and Appeals: Send us a secure email to ensure that information remains private. Send this secure email to [email protected].

Medication Therapy Management Program
You may qualify for additional medication review if you have certain conditions and numbers of medications. This additional review is known as the Medication Therapy Management Program.

For information about the Formulary and whether your medications are covered, covered alternatives to your medications, any special requirements for your medications such as prior authorization, quantity limits and step therapy, and medication costs please access the Member Benefits Portal.

Pharmacy Directory

Partnership members are able to receive their medications through the Community Care Pharmacy or from contracted network pharmacies. Care teams are available to assist members in obtaining their medications. The pharmacies in our network are listed in your provider directory. In addition, you can easily find a network pharmacy in your area by using our online pharmacy directory. Please use this Pharmacy Directory introduction with your search results.