First Health Part D | Coventry Medicare

Get the most from your prescription drug plan

Our plans offer the drug coverage you need, a nationwide pharmacy network and 24-hour Member Services. You can use the following tools and references to help you get the most from your plan.

Need coverage?

Find the right Medicare plan for you:

Compare plans & enroll

Manage your plan

For 2018

Check our drug list (collapsed): Our prescription drug list (formulary) shows:

The drugs we cover

The tier a drug is on – generally, the lower the tier, the less you pay

Drug requirements or limits

Mail order availability

Use our online search tool to see if your drug is covered

Search for your prescription drugs

Or view a full list of covered drugs

For Premier Plus plans

List of Covered Drugs (Formulary) - English

List of Covered Drugs (Formulary) - Spanish

Drug List Changes

Prior Authorization Information

Step Therapy Information

For Value Plus plans- A2

List of Covered Drugs (Formulary) - English

List of Covered Drugs (Formulary) - Spanish

Drug List Changes

Prior Authorization Information

Step Therapy Information

For Value Plus plans- A3B

List of Covered Drugs (Formulary) - English

List of Covered Drugs (Formulary) - Spanish

Drug List Changes

Prior Authorization Information

Step Therapy Information
Find a pharmacy (collapsed): Use our online search tool to find network pharmacies for your plan.

Find a Pharmacy

Members can also request a printed copy of the pharmacy directory.

Request a copy of your pharmacy directory

Our pharmacy information is updated often, but is subject to change without notice.

Save money by using preferred pharmacies

Review our 2018 preferred pharmacies list
View benefits, check claims, pay your premium & more (collapsed): We make it easy to manage your plan:

View Your Coverage & Benefits

Check Your Claims

Get an ID Card

Pay Your Premium
Star Ratings (collapsed): Each year, Medicare rates health and prescription drug plans on a Five–Star Quality Rating System. The Star ratings measure Medicare Advantage plans based on five areas:

Staying healthy

Managing chronic (long-term) conditions

Member experience with the health plan

Member complaints

Health plan customer service

Our Medicare Advantage Prescription Drug (MAPD) plans have received high ratings by the Centers for Medicare and Medicaid Services (CMS) in the annual Star Ratings, released on Oct. 12, 2016. For 2017, our MAPD plans earned an overall weighted average rating of 4.0 out of 5.0 stars. We are proud that 91 percent of our Medicare members are enrolled in plans rated 4.0 stars or higher — a 4 percent increase from last year.

Star Ratings for 2018 plans won’t be available from Medicare until later in October. We’ll post them here as soon as they’re available.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

For 2017

Check our drug list (collapsed): Our prescription drug list (formulary) shows:

The drugs we cover

The tier a drug is on – generally, the lower the tier, the less you pay

Drug requirements or limits

Mail order availability

Use our online search tool to see if your drug is covered

Search for your prescription drugs

Or view a full list of covered drugs

For Premier Plus plans

List of Covered Drugs (Formulary) - English - Spanish

Drug List Changes

Prior Authorization Information

Step Therapy Information

For Value Plus plans

List of Covered Drugs (Formulary) - English - Spanish

Drug List Changes

Prior Authorization Information

Step Therapy Information
Find a pharmacy (collapsed): Use our online search tool to find network pharmacies for your plan.

Find a Pharmacy

Our pharmacy information is updated often, but is subject to change without notice.
View benefits, check claims, pay your premium & more (collapsed): We make it easy to manage your plan:

View Your Coverage & Benefits

Check Your Claims

Get an ID Card

Pay Your Premium
Star Ratings (collapsed): Each year, Medicare rates health and prescription drug plans on a Five–Star Quality Rating System. The Star ratings measure Medicare Advantage plans based on five areas:

Staying healthy

Managing chronic (long-term) conditions

Member experience with the health plan

Member complaints

Health plan customer service

Our Medicare Advantage Prescription Drug (MAPD) plans have received high ratings by the Centers for Medicare and Medicaid Services (CMS) in the annual Star Ratings, released on Oct. 12, 2016. For 2017, our MAPD plans earned an overall weighted average rating of 4.0 out of 5.0 stars. We are proud that 91 percent of our Medicare members are enrolled in plans rated 4.0 stars or higher — a 4 percent increase from last year.

View 2017 First Health Part D Star Ratings

Star Ratings - English

Star Ratings - Spanish

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Other drug references

Changes to the drug list (formulary) (collapsed): We update our covered drug list monthly. We may make changes based on findings from:

The Food and Drug Administration (FDA)

The Centers for Medicare & Medicaid Services (CMS)

Clinical standards of care

We don’t often discontinue or reduce drug coverage during the plan year. If we remove drugs from our list or add prior authorization, quantity limits or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify you. This must be at least 60 days before the change is effective. Or it may be when you request a refill of the drug. Then you’ll get a 60-day supply of the drug.

If the FDA views a drug on our formulary as unsafe or the drug maker removes the drug from the market, we’ll remove the drug from our formulary. We’ll send you a notice if you’re taking the drug.
Prior authorization, quantity limits & step therapy (collapsed): Some covered drugs may have additional requirements or limits. These include:

Prior authorization
You or your doctor may need approval for certain drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug.

Quantity limits
For certain drugs, we limit the amount of the drug. We may limit coverage to 30 tablets for a 30-day supply. We may also limit fills to a one-month or three-month supply.

Step therapy
In some cases, we require you to first try certain drugs to treat your condition before we cover another drug for that condition. For example, if drug A and drug B both treat your condition, we may not cover drug B unless you try drug A first. If drug A doesn't work for you, we'll then cover drug B.

Look in the formulary for more requirements or limits.

If you’re a member, you can request an exception if your drug has a prior authorization, quantity limit, or step therapy requirement, or if the drug isn't covered on our formulary.

Request an exception online
Transition rules (collapsed): You may be on drugs that aren't on our drug list or covered with added requirements or limits.

Talk with your doctor

Your doctor can help you decide if you should switch to a covered drug or request a drug exception. It may help to share your formulary with your doctor. In the meantime, we may cover a temporary supply of your drug in certain cases during your first 90 days.

Transition supply

For any of your drugs not on our drug list or covered with additional requirements or limits, we'll cover up to a 30-day supply. This temporary supply should allow you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.

You must fill your prescription at a plan network pharmacy.

After your 30-day transition supply, we won't pay for these drugs unless you get approval for a drug exception. This is even if you're a plan member less than 90 days.

Learn more about our transition process

Details about our 2018 transition process

Transition of coverage enrollment letter

Transition of coverage enrollment letter (Spanish)

Details about our 2017 transition process

Transition of coverage enrollment letter

Transition of coverage enrollment letter (Spanish)

Long-term care facility residents: read this
(collapsed)

You can refill your prescription until we've given you a transition supply (91-98-day supply). This may depend on drug maker packaging or if you have a prescription written for fewer days.

We’ll cover more than one refill of these drugs for the first 90 days you’re a plan member.

If you need a drug that’s not on our list or if your ability to get your medicine is limited, but you’re past the first 90 days of membership, we’ll cover up to a 31-day emergency supply of that drug.

If you’re discharged or move to a new long-term care facility, your doctor or pharmacy can request a one-time prescription override. This will give you up to a 30-day supply for that drug.

Participating physicians, hospitals and other health care providers are independent contractors. They're neither agents nor employees of Coventry. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change.

Welcome to First Health Part D

Get the most from your prescription drug plan

Need coverage?

Manage your plan

For 2018

Check our drug list

Find a pharmacy

View benefits, check claims, pay your premium & more

Star Ratings

For 2017

Other drug references

Changes to the drug list (formulary)

Prior authorization, quantity limits & step therapy

Transition rules

We're here to help