In-network with Ascension St. John, Hillcrest, OSU Medical and Saint Francis (other providers are available in our network).
EOBs for plan members are temporarily unavailable to view online. If you have questions about plan benefits, please contact the CommunityCare customer service team for assistance.
Attention: CommunityCare will be performing systems maintenance Friday, March 1st starting at 5 p.m. through midnight on Saturday, March 2nd. Some online documents, tools and resources may be unavailable during this time. Thank you for your patience.

Comprehensive Formulary

Use the links below to access the Senior Health Plan Comprehensive and Abridged Formularies.


Abridged Formulary

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you. Call Customer Services for more information.

Important Message About What You Pay for Insulin – You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.

Part B Rebatable Drug Coinsurance Adjustment

Effective April 1, 2023, certain Medicare Part B drugs may have a lower coinsurance than what is stated in a member’s benefit documents. Members may pay a lower coinsurance if the price of the drug is rising faster than the rate of inflation. The Centers for Medicare & Medicaid Services (CMS) makes the determination on which Part B drugs qualify for the lower coinsurance and the coinsurance adjustment amount. CMS has the right to review and change this list of drugs up to 4 times a year. The Rebatable Drug Coinsurance Adjustment will occur through an enrollee refund if the mandatory reduction occurs after claims have been processed in 2023.

Part B Insulin Cost Sharing Cap

Starting July 1, 2023, Medicare Advantage plans must cover Part B insulin for use in insulin pumps at the copayment and coinsurance cap of $35 for a one-month supply of insulin.


Extended Day Supply for Platinum and Platinum Plus members on Tier 1 medications (100 days or more)

Enjoy the convenience of extended supplies on select Tier 1 medications (100 days or more) and pay $0 copay.


Formulary Changes and Utilization Management Criteria

2023 Senior Health Plan Utilization Management Criteria Documents
  Formulary Changes Prior Authorization Step Therapy Quantity Limits
JanuaryN/AJanuary 2023 Prior Authorization CriteriaJanuary 2023 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
FebruaryN/AFebruary 2023 Prior Authorization Criteria February 2023 Step Therapy Criteria See comprehensive formulary for quantity limits.
MarchMarch 2023 Formulary ChangesMarch 2023 Prior Authorization CriteriaMarch 2023 Step TherapySee comprehensive formulary for quantity limits.
AprilApril 2023 Formulary ChangesApril 2023 Prior Authorization CriteriaApril 2023 Step Therapy See comprehensive formulary for quantity limits.
MayMay 2023 Formulary ChangesMay 2023 Prior Authorization CriteriaMay 2023 Step TherapySee comprehensive formulary for quantity limits.
JuneJune 2023 Formulary ChangesJune 2023 Prior Authorization CriteriaJune 2023 Step Therapy See comprehensive formulary for quantity limits.
JulyJuly 2023 Formulary ChangesJuly 2023 Prior Authorization CriteriaJuly 2023 Step Therapy See comprehensive formulary for quantity limits.
AugustAugust 2023 Formulary ChangesAugust 2023 Prior Authorization CriteriaAugust 2023 Step TherapySee comprehensive formulary for quantity limits.
SeptemberSeptember 2023 Formulary ChangesSeptember 2023 Prior Authorization CriteriaSeptember 2023 Step TherapySee comprehensive formulary for quantity limits.
OctoberOctober 2023 Formulary ChangesOctober 2023 Prior Authorization CriteriaOctober 2023 Step TherapySee comprehensive formulary for quantity limits.
NovemberNovember 2023 Formulary ChangesNovember 2023 Prior Authorization CriteriaNovember 2023 Step TherapySee comprehensive formulary for quantity limits.
DecemberDecember 2023 Formulary ChangesDecember 2023 Prior Authorization CriteriaDecember 2023 Step TherapySee comprehensive formulary for quantity limits.

HPMS Formulary ID: 00023105 Version 18
HPMS Formulary Approval Date: 11/21/2023
Updated: 12/2023



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