Below are helpful resources and information related to your pharmacy benefits. The documents listed below are in PDF format. You will need Adobe Acrobat Reader to view these documents.

PHARMACY INFORMATION AND FORMS

Positive Healthcare Partners Abridged Formulary

Positive Healthcare Partners Pharmacy Directory (coming soon)

Appeals and Grievances Information

Appointment of a Representative Information

Form CMS-1696 (Appointment of a Representative)

Coverage Determination Information

Medication Therapy Management Program Information

Prior Authorization Form / Drug Formulary Exception Form

For information about the Centers for Medicare and Medicaid (CMS) policy regarding "Best Available Evidence" when applying for "extra help" or low income subsidy (LIS), click here.

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above - the link will open a new window and take you to the Adobe website.

You may request printed copies of the above forms and booklets by contacting our Members Services department at:

(888) 456-4715, TTY/TDD 711
Monday - Friday, 8 am - 8 pm EST