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.

Adobe Acrobat Reader icon Apple icon Note: If you are using an Apple mobile device (iPhone or iPad) please download the FREE Adobe Acrobat Reader app to ensure you can view our formularies.

Find out which drugs are covered with your plan:
2019 Pharmacy Benefit Dimensions PDP Part D Formulary

2019 Prior Authorization Criteria (Pharmacy Benefit Dimensions PDP): Some drugs require you (or your physician) to get prior authorization.
2019 Pharmacy Benefit Dimensions PDP Prior Authorization Criteria

2019 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.
2019 Pharmacy Benefit Dimensions PDP Step Therapy Criteria

2019 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.
2019 Pharmacy Benefit Dimensions PDP Quantity Limits

2018 Prior Authorization Criteria (Pharmacy Benefit Dimensions PDP): Some drugs require you (or your physician) to get prior authorization.
2018 Pharmacy Benefit Dimensions PDP Prior Authorization Criteria
2018 Labor Management Healthcare Fund PDP Prior Authorization Criteria
2018 Niagara County PDP D0122 Prior Authorization Criteria
2018 Niagara County PDP D457-464 & D465 Prior Authorization Criteria
2018 City of Stamford PDP Prior Authorization Criteria
2018 Plumbers’ and Pipefitters Welfare Educational Fund PDP Prior Authorization Criteria

2018 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.
2018 Pharmacy Benefit Dimensions PDP Step Therapy Criteria
2018 Labor Management Healthcare Fund PDP Step Therapy Criteria
2018 Niagara County PDP D0122 Step Therapy Criteria
2018 Niagara County PDP D457-464 & D465 Step Therapy Criteria
2018 City of Stamford PDP Step Therapy Criteria

2018 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.
2018 Pharmacy Benefit Dimensions PDP Quantity Limits
2018 Labor Management Healthcare Fund PDP Quantity Limits
2018 Niagara County PDP D0122 Quantity Limits
2018 Niagara County PDP D457-464 & D465 Quantity Limits
2018 City of Stamford PDP Quantity Limits
2018 Plumbers’ and Pipefitters Welfare Educational PDP Quantity Limits

2019 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:

2019 PDP Pharmacy Directory
Search our Pharmacy tool
PDP Pharmacy Directory Addendum – Effective March 15, 2018
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.


S4501_485_M
Last Updated 10/01/2018

Senior couple shaking hands with a doctor.

Questions? Contact Us.

Phone:
(716) 250-4401 or
1-800-665-1502 (TTY: 711)

Email:
Medicare Service

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

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

Pharmacy Benefit Dimensions PDP Claim Form