Pharmacy and prescription drug resources
Our Pharmacy Department wants to help you use your Medicare Part D benefit to your advantage. Check our drug list (formulary) to see if your prescription is covered. Find important forms that will help you and/or your provider get the service you need.
If you need any help from our Pharmacy team, call us at 503-416-4279 or toll-free 888-712-3258, TTY 711. Our hours are: October 1 through March 31, 8 a.m. to 8 p.m. daily; and April 1 through September 30, 8 a.m. to 8 p.m., Monday-Friday.
Medicare Part D coverage determinations, formulary exceptions and appeals
Send in a paper form
If you would like to use CareOregon Advantage's Coverage Determination/Exception Request form, call Customer Service or print the form here. You may also use the Request for Prescription Drug Coverage Determination form provided by Medicare.
If you are in hospice and you are on a drug that is not covered by your hospice program, your prescriber or hospice program can use the Hospice Prior Authorization form.
Send in electronicallyTo securely send us your coverage determination, exception request or appeal, click on the button below and enter your information.
If you would like to appeal a coverage decision, click on the link below and fill out the form.
For more information on who can request a Medicare Part D coverage determination, formulary exception or appeal, read "How do I appeal a decision not to cover a drug that my provider or I requested?" on the frequently asked questions about prescription drugs page.
In certain circumstances, you may have to pay full price for your prescription drugs up front, out of your own pocket. If you use your plan benefits correctly and are requesting that CareOregon Advantage reimburse you for these costs, you can fill out a form and send it to us.To request a reimbursement, start by downloading a Pharmacy Reimbursement form or call us at the number above and request a form be mailed to you. You'll need to complete the form in its entirety and mail it to the address indicated on the form.
We want to make sure your transition to our health plan or a new year is as smooth as possible! Please read our transition policy for more information.
Pending CMS Approval
Page last updated: October 1, 2022