Policies & Procedures
Page last updated: October 01, 2023
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A Comprehensive Formulary is a list of covered drugs selected by Care N’ Care. We generally cover drugs listed in our formulary as long as it is medically necessary, the prescription is filled at a Care N’ Care network pharmacy, and other plan rules are followed.
You can search for medications on our formulary online, or download the Comprehensive Formulary under the Plan Documents. If you prefer, we will mail you a copy of the most recent version.
- Members, please contact your Care N’ Care Customer Experience Team at 1-877-374-7993 (TTY 711), October 1 – March 31, 8 am – 8 pm, (CST) seven days a week or April 1 – September 30, 8 am – 8 pm (CST), Monday through Friday. Or send an email to yourteam@cnchealthplan.com.
- Prospective members, please call 1-800-994-1076 (TTY 711), October 1 – March 31, 8 am – 8 pm, (CST) seven days a week or April 1– September 30, 8 am – 8 pm (CST), Monday through Friday
For more information on how to fill your prescriptions, please review your Evidence of Coverage (EOC) document available on the Plan Documents page.
The Medicare program allows Care N’ Care to make changes in our formulary at any time during the calendar year. A change in our formulary can change which drugs are covered, the members’ copay and limit on usage. If the plan makes any negative non-maintenance formulary change, members affected will receive written notice which explains the change and the formulary posted on our website will be updated. For a list of changes made to the formulary, please see the formulary addendum available on the Plan Documents page. For more information on formulary changes, please review your Comprehensive Formulary document available on the Plan Documents page.
Formulary Restrictions
Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include prior authorization and quantity limits. For more information on formulary restrictions, see the Formulary Restrictions page or review your Evidence of Coverage (EOC) document or Comprehensive Formulary available on the Plan Documents page.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
