Medicare Advantage Part D pharmacy benefits

Medications can play a significant role in your health care. The following information from WellFirst Health — Provided by SSM Health Plan — will help guide your decisions about medications and answer questions about your Medicare pharmacy benefits.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week
• The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778
• Your state Medicaid office.

Formulary (List of covered drugs)

• See a list of covered medications in our comprehensive formulary.

Drugs with special requirements

• Some drugs require Step Therapy or Prior Authorization. Learn more about drugs with special requirements. 

Utilization management for prescription drugs

• Some covered medications have additional requirements, such as a prior authorization requirement or limits on coverage. See the requirements and view our prior authorization forms.

Part D coverage determinations, exceptions, appeals and grievances

• View and learn more about Part D coverage determinations, exceptions, appeals and grievances.

WellFIrst Advantage medical management

• Request authorization of services that require prior authorization, including medical drug injectables.

Pharmacy benefit guideline FAQ

• Read some common questions and answers on Medicare pharmacy (Part D) topics.

Pharmacy transition process

• Learn about our pharmacy transition process for prescription drug coverage when you are a new member to plan, a returning member, when you change locations of care, and other special circumstances.

Find a pharmacy

• Search for participating pharmacies or learn about our nationwide pharmacy network available through Medicare Advantage plans. And see more information about using out-of-network pharmacies.

Vaccine coverage

• See how some vaccines are covered under the Part D benefit and when vaccines are covered under Medicare Part B.

Medication therapy management program

• Read about our medication therapy management program.

Drug overutilization review program

• Learn how we meet the CMS requirement to prevent clinically inappropriate overuse of opioid medicines and acetaminophen.

You can contact our Customer Care Center if you need additional information, including:

• How we control the use of services and costs
• The number of appeals and grievances filed by our members
• A summary description of how we pay our doctors
• A description of our financial condition, including a summary of our most recent audit statement