Medicare Advantage Prescription Drug Prior Authorizations, Appeals and Grievances

Your plan has a "formulary" that lists drugs that are covered, and most can be obtained by simply presenting your prescription at a participating pharmacy and paying your part of the cost. A few other drugs need to be authorized in advance for medical necessity, and some drugs are not covered at all. Your formulary generally has at least two drugs in each category, so you should almost always be able to find an alternative that works for you.

This page provides answers to frequently asked questions about procedures for obtaining drugs or filing complaints about your benefits, and we hope you find it useful. Please contact your Customer Service Representative if you need any additional assistance.

Other Appeals and Grievances Information

Please contact your Customer Service Representative for information related to the aggregate number of appeals, grievances, and exceptions filed with the Plan, and for information regarding the process or status of your case.

How to contact Medicare

Your Customer Service Representative is dedicated to personally solving any problems you may have with us and our providers to your full satisfaction. If you prefer to contact the Centers for Medicare and Medicaid Services (CMS) directly, please visit Medicare's web site:

Health First Health Plans is an HMO plan with a Medicare Contract. Enrollment in Health First Health Plans depends on contract renewal.

Y0089_EL108951_M | Accepted date: 10/01/2024
Last updated: 10/01/2024