PDP Prescription Drugs (2014)

Formulary (drug list) — These documents lists the drugs covered by each plan:

Basic Formulary



Prescription reimbursement form 

 Prior authorization criteria

Transition policy 

Medication therapy management, and drug and/or utilization management

Step therapy criteria 

Extra help for prescription drug costs

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
  • Your local Social Security office.
  • Your State Medicaid Office.

Assistance with Best Available Evidence for Low Income Subsidy 

Monthly plan premiums for people who get extra help from
Medicare to help pay for their prescription drug costs

Y0089_MP3537 Approved 11/06/2013
Last updated: 10/1/2013