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Pharmacy and Prescription Drug Resources

Our Pharmacy Department wants to help you use your Medicare Part D prescription drug benefit to your advantage. Check our Formulary (Drug List) to see if your prescription is covered. Find important forms that will help you and/or your provider get the service you need. And remember, our Customer Service Team is always available to help you.

Customer Service:

Hours: 8 a.m. - 8 p.m., Daily.

Medicare Part D Coverage Determinations, Formulary Exceptions and Appeals

Send in a Paper Form

Coverage Determinations

If you would like to use CareOregon Advantage's Coverage Determination/Exception Request Form, call Customer Service or print the form here.

You may also use the Request for Prescription Drug Coverage Determination form provided by Medicare.

If you are in hospice and you are on a drug that is not covered by your hospice program, your prescriber or hospice program can use the Hospice Prior Authorization Form.

Send in Electronically

To securely send us your coverage determination, exception request or appeal, click on the button below and enter your information.

Appeals

If you would like to appeal a coverage decision, you may use the forms below.

For more information on who can request a Medicare Part D coverage determination, formulary exception or appeal, read "How do I appeal a decision not to cover a drug that my provider or I requested?" in the Common Questions about Prescription Drugs section.

Drug Reimbursement

In certain circumstances, you may have to pay full price for your prescription drugs up front, out of your own pocket. If you use your plan benefits correctly and are requesting that CareOregon Advantage reimburse you for these costs, you can fill out a form and send it to us.

To request a reimbursement, start by downloading a Pharmacy Reimbursement Form or call us at the number above and request a form be mailed to you. You'll need to complete the form in its entirety and mail to the address indicated on the form.

Pharmacy Transition

We want to make sure your transition to our health plan or a new year is as smooth as possible. Please read our transition policy for more information.

CareOregon Advantage Plus is an HMO-POS SNP with a Medicare/Medicaid contract.  Enrollment in CareOregon Advantage Plus depends on contract renewal. 

CareOregon Advantage Star is an HMO plan with a Medicare contract. Enrollment in CareOregon Advantage Star depends on contract renewal.

   Page last updated: October 1, 2018   
    H5859_CO2019_4006_M CMS ACCEPTED   

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