2021 Prescription Drug Information & Documents
Click here for 2022 Prescription Drug Information & Documents
Click here to use our drug look up tool to view a list of covered medications
If you would like a friend, relative, your doctor or other provider, or
other person to be your representative to ask for a coverage decision
or make an appeal, please call Member Services at 1-833-866-6559 (TTY
users call 1-800-955-8770). From October 1 through March 31, we are open
8 a.m. – 8 p.m. local time, seven days a week. From April 1 through
September 30, we are open 8 a.m. – 8 p.m. local time, Monday –
Friday. Ask for the “Appointment of Representative” form.
(The form is also available on Medicare’s website via the link below).
The form gives that person permission to act on your behalf. It must be
signed by you and by the person who you would like to act on your behalf.
You must send us a copy of the signed form. Instructions on where to send
the form are included in the form