Our Sales & Enrollment Team is available 8 a.m. to 8 p.m., 7 days a week through December 7th.

Comprehensive Formulary

Use the links below to access the CommunityCare Options 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 and 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 CommunityCare Options Utilization Management Criteria Documents
  Formulary Changes Prior Authorization Step Therapy Quantity Limits
JanuaryJanuary 2024 Formulary ChangesJanuary 2024 Prior Authorization CriteriaJanuary 2024 Step TherapySee comprehensive formulary for quantity limits.

HPMS Formulary ID: 00024113 Version 7
HPMS Formulary Approval Date: 9/29/2023
Updated: 01/2024

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