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.

Comprehensive Formulary

Use the links below to access the INTEGRIS Health Partners+ 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 2024.

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

2024 INTEGRIS Health Partners+ Utilization Management Criteria Documents
  Formulary Changes Prior Authorization Step Therapy Quantity Limits
JanuaryN/AJanuary 2024 Prior Authorization CriteriaJanuary 2024 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
FebruaryFebruary 2024 Formulary ChangesFebruary 2024 Prior Authorization CriteriaFebruary 2024 Step TherapySee comprehensive formulary for quantity limits.
MarchMarch 2024 Formulary ChangesMarch 2024 Prior Authorization CriteriaMarch 2024 Step TherapySee comprehensive formulary for quantity limits.
AprilApril 2024 Formulary ChangesApril 2024 Prior Authorization Criteriaupdated 4/11/2024April 2024 Step TherapySee comprehensive formulary for quantity limits.

HPMS Formulary ID: 00024112 Version 10
HPMS Formulary Approval Date: 03/19/2024
Updated: 04/2024



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