Pharmacy Part D

CHRISTUS Health Plan has partnered with CVS Caremark® to manage your prescription benefit plan and help keep your medication costs low.

Use the Pharmacy Locator tool to find a pharmacy in our network near you.

Use the Formulary Drug Search tool to view the tiering or authorizations of your current medications.

Connect to your CVS Caremark account via your Member Portal to manage your medications, set up auto-refills for maintenance medications, and much more.

Prescription Drug Coverage for Medicare Part D

As a member of CHRISTUS Health Medicare Complete or Medicare Plus you have prescription drug coverage for Medicare Part D in addition to medical and hospital benefits.

  • To see if CHRISTUS Health Plan covers a specific prescription drug, please search our downloadable, or online formulary below.
  • To keep costs low for members and reduce medication errors, we use utilization management practices and drug utilization reviews.

View our pharmacy management procedures.

Managing Resources and Medications

Utilization Management, Prior Authorization, Quantity Limits, Step Therapy and Generic Substitution 

Utilization management is a practice where some medical services and drugs are evaluated for need before they can be used. This means that for certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these rules to help members use drugs effectively and keep coverage affordable.

Examples of utilization management include:

Prior Authorization

We may require you to get approval from us before you fill certain prescriptions. If you don’t get approval, we may not provide coverage for the drug.

Downloadable List of Prescriptions that require a Prior Authorization per plan coverage year.

Quantity Limits

We may limit or only cover a certain amount of a drug per prescription or for a period of time.

Step Therapy

In some cases, members may need to try one drug to treat their condition before we will provide coverage for another drug.

Downloadable List of Prescriptions that are part of Step Therapy utilization per plan year.

Generic Substitution

When a generic version of a drug is available, our pharmacies will automatically give members that version unless your doctor has told us that you must take the brand name drug.

You can find out if your drug is subject to these additional requirements or limits by looking in our formulary. If your drug does have additional restrictions or limits, you can ask us to make an exception to our coverage rules.

What is a Drug Utilization Review? 

During a drug utilization review, we check your prescriptions and look for problems like:

  • Possible medication errors
  • Duplicate drugs that are unnecessary
  • Drugs that are inappropriate because of your age or gender
  • Possible harmful interactions between drugs you are taking
  • Drug allergies or dosage errors

These reviews are especially important if you have multiple doctors who prescribe medications.

We conduct reviews each time you fill a prescription and on a regular basis. If we see a problem during our review, we will work with your doctor to correct it.

(Determination and Exceptions) What if I Disagree with a Decision?  

A coverage determination is a decision made by CHRISTUS Health Plan regarding payment, dosage limits prior authorization and other matters with prescription drugs. Coverage determinations can be requested if a member disagrees with:

  • Receipt or payment for a prescription drug that a member believes may be covered
  • A tiering or formulary exception
  • The amount that CHRISTUS Health Plan requires a member to pay for a Part D prescription drug
  • The limit on the quantity or dose of a requested drug
  • A requirement that a member try another drug before CHRISTUS Health Plan will pay for the requested drug
  • A decision on whether the member has or has not satisfied a prior authorization or other utilization management requirement

How to Request a Part D Coverage Determination or Exception

A member, their representative, or a prescribing physician may request a coverage determination by calling 1-855-344-0930 or filling out the Part D Coverage Determination Request Form. Complete the form and fax it to 1-855-633-7673 or mail it to:

CVS Caremark
P.O. Box 52000
MC109
Phoenix, AZ 85072-2000

This form is also available in Spanish. Solicitud de determinación de cobertura de medicamentos recetados de Medicare.

A member, their representative, or a prescribing physician may also request a coverage determination by selecting the link below and completing the information.

Part D Coverage Determination & Exception Decisions

For requests for benefits that do not involve exceptions, the Plan will provide notice of its decision within 72 hours after receiving an expedited request or 7 days after receiving a standard request.

For requests for benefits that involve exceptions, the adjudication timeframes do not begin until the member’s prescriber submits his or her supporting statement to the Plan for review.

For payment requests, including payment requests that involve exceptions, CHRISTUS Health Medicare Advantage will provide written notice of its decision (and make payment when appropriate) within 14 calendar days after receiving a request.

If CHRISTUS Health Medicare Advantage coverage determination is unfavorable, the decision will contain the information needed to file a request for appeal / redetermination with the Plan.

What is a Formulary?

A formulary is a list of prescription drugs covered by your CHRISTUS Health Medicare Complete Plan or Medicare Plus Plan. The drugs on this list are selected by the CHRISTUS Health Plan with the help of doctors and pharmacists.

The formulary also provides a brief description of your coverage. Below we provide you with a comprehensive formulary (a complete listing of covered drugs) plans and an abridged formulary (a partial listing of covered drugs) for your convenience to download. Additionally, we offer you an online searchable version.

Downloadable Formulary

Programs

Medicare Prescription Payment Plan
Medication Therapy Management Program

Medication Therapy Management (MTM) is a free service for members who take multiple medications for multiple health conditions.

Medication Therapy Management Program
Over the Counter Drug Program

If you are a member of a CHRISTUS Health Plan Medicare Complete (HMO), Medicare Plus (HMO), or Medicare Guardian (HMO) plan, you have access to an over-the-counter (OTC) pharmacy benefit.

Over the Counter Drug Program

H1189_WEB25MM3012_M | Last Updated 4/8/26