Formularies  Pharmacies

The following information will help you understand which drugs are covered as well as where you can find participating pharmacies and mail order services available to you.

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2021 Prior Authorization Criteria (Pharmacy Benefit Dimensions PDP): Some drugs require you (or your physician) to get prior authorization.

2021 Pharmacy Benefit Dimensions PDP Part D 3 Tier Prior Authorization Criteria
2021 Pharmacy Benefit Dimensions PDP Part D 5 Tier Prior Authorization Criteria

2021 Step Therapy Criteria (Pharmacy Benefit Dimensions PDP): In some cases, Independent Health requires that you first try certain drugs to treat your medical condition before we will cover another drug for that condition.

2021 Pharmacy Benefit Dimensions PDP Part D 3 Tier Step Therapy Criteria
2021 Pharmacy Benefit Dimensions PDP Part D 5 Tier Step Therapy Criteria

2021 Formulary Quantity Limits (Pharmacy Benefit Dimensions PDP): Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified.

2021 Pharmacy Benefit Dimensions PDP Part D 3 Tier Quantity Limits
2021 Pharmacy Benefit Dimensions PDP Part D 5 Tier Quantity Limits

2020 Prior Authorization Criteria (Pharmacy Benefit Dimensions PDP): Some drugs require you (or your physician) to get prior authorization.

2020 Pharmacy Benefit Dimensions PDP Prior Authorization Criteria
2020 Labor Management Healthcare Fund PDP Prior Authorization Criteria
2020 Niagara County PDP Group D0122 Formulary Prior Authorization Criteria
2020 Niagara County PDP Group 0457-0464 & D0465 Prior Authorization Criteria
2020 City of Stamford PDP Prior Authorization Criteria
2020 Plumbers’ and Pipefitters Welfare Educational Fund PDP Prior Authorization Criteria

2020 Step Therapy Criteria (Pharmacy Benefit Dimensions PDP): In some cases, Independent Health requires that you first try certain drugs to treat your medical condition before we will cover another drug for that condition.

2020 Pharmacy Benefit Dimensions PDP Step Therapy Criteria
2020 Labor Management Healthcare Fund PDP Step Therapy Criteria
2020 Niagara County PDP Group D0122 Formulary Step Therapy Criteria
2020 Niagara County PDP Group 0457-0464 & D0465 Step Therapy Criteria
2020 City of Stamford PDP Step Therapy Criteria

2020 Formulary Quantity Limits (Pharmacy Benefit Dimensions PDP): Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified.

2020 Pharmacy Benefit Dimensions PDP Quantity Limits
2020 Labor Management Healthcare Fund PDP Quantity Limits
2020 Niagara County PDP Group D0122 Formulary Quantity Limits
2020 Niagara County PDP Group 0457-0464 & D0465 Quantity Limits
2020 City of Stamford PDP Quantity Limits
2020 Plumbers’ and Pipefitters Welfare Educational Fund PDP Quantity Limits

2021 Plan Transition Process PDP and 2020 Plan Transition Process PDP: If you are new to the plan, we can help you transition when your current drugs are not on the formulary or your ability to get your drugs is limited.

You are covered both locally and nationally with our extensive pharmacy network. For the full list of participating locations, view our pharmacy directory:

2021 PDP Pharmacy Directory
2020 PDP Pharmacy Directory
Search our Pharmacy tool
Home Infusion Pharmacies – States Licensed

Members of Pharmacy Benefit Dimensions PDP can utilize mail order pharmacy services through Wegmans and ProAct Mail Order Pharmacy.

Learn more about Wegmans Mail Order Pharmacy Services and ProAct Mail Order Pharmacy Services and get helpful tips on how to use your mail order pharmacy.

Registration Forms

Wegmans Mail Order Pharmacy Registration Form
ProAct Mail Order Pharmacy Registration Form
ProAct Automatic ReFill registration form

Pharmacy Benefit Dimensions is a subsidiary of Independent Health. Independent Health is a PDP with a Medicare contract. Enrollment in Pharmacy Benefit Dimensions PDP depends on contract renewal between Independent Health and CMS.

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Last Updated 10/01/2020

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Questions? Contact Us.

Phone:
(716) 504-4444 or
1-800-667-5936 (TTY: 711)

Email:
Medicare Service

Hours:
October 1 – March 31: Monday – Sunday,
8 a.m. – 8 p.m. ET

April 1 – September 30: Monday – Friday,
8 a.m. – 8 p.m. ET

Pharmacy Benefit Dimensions PDP Claim Form