Forms & Documents
Instructions on How to Get Covered Services During a Disaster.
Medicare Plans
VitalCare (HMO C-SNP) 021
VitalCare (HMO C-SNP) 022
Member Notices and Updates
Member Announcements
Plan Changes and Disenrollment Information
Plan Changes and Disenrollment
Prescription Drug Benefits
Prescription Drug Benefits
- 2024 Catalog Over-the-Counter (OTC) Items
- 2024 Part D Transition Policy
- 2024 Prescription Drug Formulary – updated 08/08/2024
- 2024 Prescription Drug Formulary Changes – updated 08/12/2024
- 2024 Prior Authorization Criteria - updated 08/08/2024
- 2024 Step Therapy Criteria - updated 08/08/2024
- 2024 Step Therapy Criteria Part B Drugs only – effective 10/30/2023
- 2024 Therapy Management Medication (MTM) Program
- Appointment of Representative Form
- B vs. D Coverage Determination Request Form
- CMS Medicare Prescription Drug Coverage Determination Request Form
- Lost, Damaged, or Stolen Medication Form
- Medication Sync Request Form
- Part D Reimbursement Request Form
- Personal Medication List Form
- Prescription Coverage Determination Request Form
- Vacation Supply Form