Skip to main content

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.

  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.

2022 Prior Authorization Criteria (Pharmacy Benefit Dimensions PDP): Some drugs require you (or your physician) to get prior authorization.
 

2022 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.
 

 

2022 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 Prior Authorization Criteria (Pharmacy Benefit Dimensions PDP): Some drugs require you (or your physician) to get prior authorization.

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 Labor Management Healthcare Fund PDP Step Therapy Criteria
2021 Niagara County PDP Group D0122 Formulary Step Therapy Criteria
2021 Niagara County PDP Group D0457-D0464 Step Therapy Criteria
2021 Niagara County PDP Group D0465 Step Therapy Criteria
2021 City of Stamford PDP 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
2021 Labor Management Healthcare Fund PDP Quantity Limits
2021 Niagara County PDP Group D0122 Formulary Quantity Limits
2021 Niagara County PDP Group D0457-D0464 Quantity Limits
2021 Niagara County PDP Group D0465 Quantity Limits
2021 City of Stamford PDP Quantity Limits

2022 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.

2021 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:

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

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_538_M
Last Updated 10/01/2021