Pharmacy Benefits (Part D Prescription Drug)
All our Dual Prime D-SNP plans include prescription drug coverage, many with low (or even no) copays. Choose from a large network of local and national pharmacies. Plus, we offer prescription drug mail-order service at no additional cost. Learn more about your pharmacy resources below:
Pharmacy benefits (Part D prescription drug)
What are Medicare Part D covered drugs?
A Part D covered drug is available only by prescription, approved by the Food and Drug Administration (FDA) and used and sold in the United States. These medications are listed on the plan’s formulary.
Medicare Part D covered drugs include:
- Prescription drugs
- Biological products
- Insulin, as defined by the Centers for Medicare & Medicaid Services (CMS)
- Certain vaccines
- Medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs and gauze)
What are Medicare Part B covered drugs?
Medicare Part B covered drugs include a limited number of prescription drugs. These include, but are not limited to:
- Durable Medical Equipment (DME) Supply Drugs (such as nebulizers, external or implantable pumps)
- Hemophilia clotting factors (self-administered clotting factors if you have hemophilia)
- Immunosuppressive Drugs (immunosuppressive drug therapy a beneficiary receives after a Medicare-covered organ transplant)
- Oral Anti-Cancer and Anti-Nausea Drugs
- Pneumococcal and Hepatitis B vaccines and administration
For additional information on Medicare Part B covered drugs, refer to your Evidence of Coverage.
What about opioid drugs?
For your safety, the number of opioid drug(s) to treat your pain will be limited based on recommendations from the U.S. Centers for Disease Control and Prevention (CDC). You may see a reduced quantity of your opioid prescription(s) when you get them filled at a network pharmacy. The quantity you receive will vary based on the opioid drug your provider has prescribed. Any opioid prescriptions for quantities greater than CDC recommendations will require prior authorization. There are additional limitations depending on whether you have used an opioid drug previously or whether you are using the opioid drug for short-term or long-term use for pain relief.
Can I get prescription drugs shipped to my home?
With CareFirst’s network mail-order delivery program, ReadyFill at Mail®, you can get prescription drugs shipped to your home. Mail-order drugs usually arrive within 10 days. Mail-order can be a convenient service for drugs you take regularly for a chronic or long-term medical condition.
Please call Part D Member Services at 1-844-786-6762 (TTY users please call 711), 24 hours a day, seven days a week, if you do not receive your mail-order drugs within a 10-day timeframe. CareFirst Medicare Advantage members please call the phone number listed on the back of your member ID card.
Search for Formulary/Drug List
The CareFirst Medicare Advantage Formulary is a list of drugs covered by the plan. The plan covers both brand name and generic drugs. If you have questions using this Formulary Search tool, please call Member Services at 844-386-6762, 24 hours a day, 7 days a week. TTY users please call 711.
Search Pharmacy Directory
You can use this Pharmacy Locator tool to locate a network pharmacy or to determine if your pharmacy is in the network, or you can call our Medicare Part D Member Services at 1-844-786-6762, 24 hours a day, 7 days a week. TTY users, please call 711.
Search Our 2021 Online Pharmacy DirectoryFind a Part D prescription medication/drug
The CareFirst Medicare Advantage Formulary is a list of drugs covered by a plan. Formularies are developed to meet the needs of most members based on the most commonly prescribed drugs, including certain prescription drugs that Medicare requires that we cover. The CareFirst Medicare Advantage’s Medicare Part D formulary is approved by Medicare and updated throughout the plan year and may change if:
- The plan no longer covers a drug.
- A new drug is added.
- A drug is moved to a different cost-sharing Tier.
- A Prior Authorization, Step Therapy restriction or Quantity Limit has been added or changed for a drug.
- A drug is removed from the market.
CareFirst Medicare Advantage covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as their brand-name equivalents. Generic drugs usually cost less than brand-name drugs and are rated by the U.S. Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
We may remove drugs from the CareFirst Medicare Advantage Part D formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier during the plan year. If the change affects a drug you take, we will notify you at least 60 days before the change is effective. However, if the U.S. Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe, or if the drug's manufacturer removes the drug from the market, we may immediately remove the drug from the CareFirst Medicare Advantage Medicare Part D formulary and notify all affected members as soon as possible.