Pharmacy Information &

Prescription Drug Coverage

For Drug coverage, what’s the difference between Medicare Part B and Part D?

Medicare Part B
Drug Coverage

Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under certain conditions.

Usually, Part B covers drugs you wouldn’t typically give to yourself, like those you get at a doctor’s office or in a hospital outpatient setting.

Medicare Part D
Drug Coverage

Medicare drug coverage (Part D) covers a wide range of prescription drugs that people with Medicare take. A list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost.

2024 Part B Drug Coverage

  • Part B Drug Prior Authorization Requirements

    For certain Part B drugs, prior approval or prior authorization from the plan may be required before the drug is covered. To learn more about the Part B drugs that require prior authorization, view the document below.

    2024 Part B Prior Authorization Drug List (PDF):  English  |  Español

  • Part B Drug Step Therapy Criteria

    In some cases for Part B Drugs, Aspire Health Plan may require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. This is called Step Therapy. For more details on Step Therapy, view the document below.

    2024 Part B Step Therapy Updates (PDF):  English  |  Español

2024 Part D Pharmacy Drug Coverage

  • Prescription Drug Formulary

    Aspire Health Plan’s prescription drug formulary or “Drug list” is a list of prescription drugs covered by the plan. The drugs on this list are selected by the plan with the help of doctors and pharmacists. The list includes both brand name and generic drugs.

    To search for a specific prescription drug, view our Online Drug Formulary

    2024 Formulary (PDF): (Last Revised 1/2024)  English  |  Español

  • Step Therapy

    In some cases, Aspire Health Plan may require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. This is called Step Therapy. For more details on Step Therapy, view the document below.

    2024 Step Therapy Updates (PDF):  English 

  • Prior Authorization

    You have the right to request an exception to the Aspire Health Plan Drug Formulary. To learn more on the types of exceptions, view the document below.

    2024 Prior Authorization Updates (PDF):  English

  • Coverage Determination Request

    Request for Medicare Prescription Drug Coverage Determination (PDF): (Last Revised 9/2019)  English  |  Español

  • Mail-Order Prescriptions

    If you rely on regular or long-term medications, there may be a better way to get your prescriptions filled. Birdi Rx is home delivery and a smart, simple way for you to get prescriptions delivered to your door.

    2024 Home Delivery Registration Form (PDF):  English  |  Español

  • Out-of-Network Pharmacy Coverage

    For a detailed description of our out-of-network pharmacy rules, check out our Evidence of Coverage documents located on our 2024 Plan Documents page.