Provider Information
- 2022 Provider Manual
- Participating Providers
- Participating Pharmacies
- Model of Care Training and Attestation
- 2022 Provider Quick Reference Guide
- Provider Information Update
Medical Information and Authorization
Pharmacy Information and Authorization
Formulary 2022
- 2022 Formulary (List of Covered Drugs)
(last updated 1/1/2022) - 2022 Formulary (List of Covered Drugs) (Spanish)
(last updated 10/15/2021) - 2022 Formulary (Prescription Drugs) Changes
(last updated 12/1/2022) - 2022 Formulary (Prescription Drugs) Changes (Spanish)
(last updated 12/1/2022) - 2022 Prior Authorization Criteria
(last updated 12/1/2022) - 2022 Step Therapy Criteria
(last updated 12/1/2022) - 2022 Quantity Limits
(last updated 12/1/2022) - 2022 Formulary (Prescription Drugs) Search Tool
- Online Part D Coverage Determination/Redetermination
- 2022 Provider Coverage Determination Form
Member Benefit Information
- 2022 Summary of Benefits
(contains multi-language insert) - 2022 Summary of Benefits (Spanish)