Pharmacy Forms |

Pharmacy Forms

Here’s a list of pharmacy forms you may need when using your Part D benefits. If you have questions about these forms, give us a call.  We’re here to help.

Updated 05/01/2020:

  • HMO List of Drugs (Formulary)  - English (PDF)
  • HMO List of Drugs (Formulary)  - Spanish (PDF)

  • HMO SNP List of Drugs (Formulary)  - English (PDF)
  • HMO List of Drugs (Formulary)  - Spanish (PDF)

 

  • Medicare Hospice Form (HMO) (PDF)

If you have questions please, contact Member Services.