View pharmacy coverage policies, reimbursement and prescription claim forms for your Medicare plan.
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Medicare policies and claim forms for prescription drugs
2026 Medicare transition policy
2026 Medicare Transition Policy – English
2026 Medicare Transition Policy – Spanish
2026 Medicare Transition Policy – Chinese
2026 Medicare Transition Policy – Korean
2026 Medicare Transition Policy – Creole
Pharmacy coverage policies
Humana Part D Direct Member Reimbursement Policy
Prescription claim forms
Medicare Prescription Drug Claim Form - English
Medicare Prescription Drug Claim Form - Spanish
Limited Income NET Prescription Drug Claim Form - English
Limited Income NET Prescription Drug Claim Form - Spanish
Additional drug info form- English
Additional drug info form- Spanish
Drug coverage determination and redetermination
Medicare Part D Coverage Determination Request Form
Medicare Part D Coverage Redetermination Request Form
Grievance and appeal request forms
Grievance/Appeal Request form - English
Grievance/Appeal Request form – Chinese
Grievance/Appeal Request form - Spanish
Appointment of Representative form - English
Appointment of Representative form - Spanish
Pharmacy Resources
Pharmacy CenterWell Pharmacy™ List of covered drugs Medicare Drug List Employee Drug List Changes to Drug List Prior authorization Medicare coverage and claim forms Drug plans and coverage Pharmacy finder Prescription savings and tools Drug Discount Program CenterWell Specialty Pharmacy™ Drug news and alerts Understanding your medications Pharmacy awards and accreditations