All of our plans include prescription drug coverage. Depending on your plan, you may be able to get some or all of your prescription medications for low or even no copay. With all of our plans you get the convenience of our large network of local and national pharmacies. Plus we offer mail-order service – with medications delivered right to your door for no additional cost.
Our coverage goes beyond simply filling your prescription. Our pharmacy systems check your new prescriptions against your medication history to prevent potential negative drug interactions and duplicate therapies. We have clinical pharmacists who can consult with your doctor in prescribing the best medication for your use.
The CareFirst Medicare Advantage Formulary is a list of drugs covered by a plan. Formularies are developed to meet the needs of most members based on the most commonly prescribed drugs, including certain prescription drugs that Medicare requires that we cover. The CareFirst Medicare Advantage’s Medicare Part D formulary is approved by Medicare and updated throughout the plan year and may change if:
CareFirst Medicare Advantage covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as their brand-name equivalents. Generic drugs usually cost less than brand-name drugs and are rated by the U.S. Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
We may remove drugs from the CareFirst Medicare Advantage Part D formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier during the plan year. If the change affects a drug you take, we will notify you at least 60 days before the change is effective. However, if the U.S. Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe, or if the drug's manufacturer removes the drug from the market, we may immediately remove the drug from the University of Maryland Medicare Part D formulary and notify all affected members as soon as possible.
If you have questions using this Formulary Search tool, please call Member Services at 1-844-786-6762, 24 hours a day, 7 days a week. TTY users please call 711.
Blood Glucose Meter Test Strips and Lancets Notice
Beginning January 1, 2020, One Touch by Lifescan, previously owed by Johnson and Johnson (J&J) is the preferred covered blood glucose meter and test strips for CareFirst Medicare Advantage members. We allow up to 100 test strips for members with Diabetes who are not using insulin or up to 300 test strips for members with Diabetes who are using insulin every 90 days. This means this is the only brand accessible at a network pharmacy. CareFirst Medicare Advantage does not have a preferred lancet/device.
If you use another brand of test strips and meter, members may work with your PCP to submit an order to a network DME provider.
Test strips and lancets needed over these quantities require an Organization Determination (OD) through CareFirst Medicare Advantage Utilization Management (UM) department. . Our UM staff will make arrangements with a network Durable Medical Equipment (DME) provider to mail you the additional test strips and/or lancets approved.
Please speak with your provider to see if test strips and/or lancets over these quantities are needed to manage your Diabetes. Your provider will contact us directly to request an Organization Determination.
Download a copy of our 2021 Comprehensive Formulary/Drug List
Download a copy of our 2021 Prior Authorization
Download a copy of our 2021 Step-Therapy Criteria
Search Our 2021 Online Formulary/Drug List
If you would like to be mailed a hard-copy of the Formulary or if you need help locating your prescribed drugs, please call toll-free.
CareFirst Medicare Advantage has a nationwide network of pharmacies, so chances are there's one near you! CareFirst Medicare Advantage in partnership with CVS Health, our Pharmacy Benefits Manager, contracts with pharmacies that equal or exceed the Center for Medicare & Medicaid Services (CMS) requirements for pharmacy access in your area. The Pharmacy Locator Tool was established to help locate participating pharmacies for you that are convenient and accessible to you!
Since the network can change year-to-year, accessing the Pharmacy Locator tool is a great way to keep current on all the in-network pharmacies. You can use this Pharmacy Locator tool to locate a network pharmacy or to determine if your pharmacy is in the network, or you can call our Medicare Part D Member Services at 1-844-786-6762, 24 hours a day, 7 days a week. TTY users, please call 711.
Search Our 2021 Online Pharmacy Directory
If you would like to be mailed a hard-copy of the pharmacy directory or if you need help finding a network pharmacy, please call toll free:
Prospective Members: 1-844-811-6334 (TTY: 711)
8 AM to 8 PM EST, 7 days a week from October 1 - March 31
8 AM to 8 PM EST, Monday through Friday from April 1 - September 30
Current Members: 844-786-6762 (TTY: 711); 24 hours a day, 7 days a week.