Provider Information
- 2021 Provider Manual
- Participating Providers
- Participating Pharmacies
- Model of Care Training and Attestation
- Provider Quick Reference Guide
- Provider Information Update
Medical Information and Authorization
- Authorization Form
- Authorization Form (Spanish)
Pharmacy Information and Authorization
Formulary 2021
- 2021 Comprehensive Formulary (Prescription Drugs)
(last updated 12/1/2021) - 2021 Comprehensive Formulary (Prescription Drugs) (Spanish)
(last updated 10/15/2020) - 2021 Formulary (Prescription Drugs) Changes
(last updated 12/1/2021) - 2021 Prior Authorization Criteria
(last updated 12/1/2021) - 2021 Step Therapy Criteria
(last updated 12/1/2021) - 2021 Quantity Limits
(last updated 12/1/2021) - 2021 Formulary (Prescription Drugs) Search Tool
- Online Part D Coverage Determination/Redetermination
Member Benefit Information
- 2021 Summary of Benefits
(contains multi-language insert) - 2021 Summary of Benefits (Spanish)