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2015 CarePlus Prescription Drug Guides and Part D Information

CarePlus offers prescription drug coverage on all of its plans.

The Prescription Drug Guide, is the list of covered Part D prescription drugs selected by CarePlus. CarePlus worked with a team of healthcare providers to make a formulary that represents the prescription drugs we believe you need for a high-quality treatment program. The list must meet requirements set by the Centers for Medicare & Medicaid Services (CMS). Medicare has approved all of our drug guides. CarePlus will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a CarePlus network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, you must review your Evidence of Coverage (EOC).

Treasure & Space Coast:

Brevard, Indian River, Martin, Okeechobee, and Saint Lucie Counties Prescription Drug Guides


Part D Utilization Management Requirements: Prior Authorization (PA), Step Therapy (ST), Quantity Limit (QL), and Exceptions

  • Palm Beach - CareFree (HMO)
  • Orlando area: Lake, Marion, Sumter - CareOne (HMO), CareDirect (HMO SNP), CareNeeds (HMO SNP)
  • Treasure Coast area: Brevard, Indian River, Martin, Okeechobee, Saint Lucie - CareOne (HMO), CareNeeds (HMO SNP)
  • Duval - CareOne (HMO), CareNeeds (HMO SNP)
  • Tampa area - CareDirect (HMO SNP)
  • Orlando area: Orange, Osceola & Seminole - CareDirect (HMO SNP)

Prescription Drug Transition Policy and Letter Template

CarePlus wants to make sure that you, as a new or existing member, safely transition into the new plan year when you have limited ability to receive your current drug therapy. You may not be able to get a drug if it's not on CarePlus' drug list or if it requires prior authorization because of quantity limits, Step Therapy requirements, or confirmation of your clinical history. To learn more about the transition process, please review our Transition Policy.

2015 TransitionPolicy-English
2015 TransitionPolicy-Spanish

Please see below Template of CarePlus' Transition Letter

2015 Transition Letter Template - English
2015 Transition Letter Template - Spanish
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H1019_CPHPEDUMKTG2015 Approved
Last Updated: 10/01/2014