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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.

View the following formularies to check which drugs are included:

Prior Authorization: Some drugs require you (or your physician) to get prior authorization. 

Step Therapy: In some cases, you are required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.

Formulary Quantity Limits: Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified.

View the following formularies to check which drugs are included:

Prior Authorization: Some drugs require you (or your physician) to get prior authorization. 

2025 Prior Authorization Criteria not included are currently pending CMS Review.

Step Therapy: In some cases, you are required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.

Formulary Quantity Limits: Certain drugs have a quantity limit, which means we’ll provide coverage only up to the limit specified.

2024 Plan Transition Process: 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 11/01/2023

Pharmacy
Benefit
Management
Expires 01/01/2026

© Pharmacy Benefit Dimensions

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