How else can we help you? This page contains resources and information for our Medicare Advantage Prescription Drug Plan Members.
Drug Coverage and Pharmacy Access
The information below explains which drugs are covered by your plan and how to locate participating pharmacies and mail-order pharmacy services available to you.
The drugs listed below are what is covered under your plan when prescribed and obtained according to plan guidelines. Note, some drugs require you (and your doctor) to get prior authorization or require step therapy.
Your plan includes access to a broad network of pharmacies both locally and nationwide. For a complete list of participating locations, please refer to the pharmacy directory.
You may be eligible to have a 90-day supply of your maintenance medication delivered to your door through a mail order pharmacy. These pharmacies will ship your medication at no cost, which could save you time and money.
More information: Mail Order Pharmacy
New to Pharmacy Benefit Dimensions and EGWP PDP Plans
If you’re new to Pharmacy Benefit Dimensions or an EGWP PDP plan, this section provides an overview of how your prescription coverage works and how to get started using your benefits.
Medicare Advantage is a Medicare approved plan from a private company that offers an alternative to original Medicare for your health and drug coverage.
Medicare Part D helps cover the cost of drugs (including many recommended shots or vaccines). You join a Medicare prescription drug plan in addition to Original Medicare (hospital and medical insurance), or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
An Employer Group Waiver Plan (EGWP) is an employer-group sponsored Medicare Part D Prescription Drug Plan (PDP) offered to retired, Medicare-eligible members and their Medicare-eligible spouse and administered by a Pharmacy Benefit Manager (PBM).
An EGWP PDP helps pay for self-administered prescription drugs through your most recent employer. This is a plan that must follow all applicable federal Medicare guidelines outlined by CMS.
If you are a new or current Medicare Part D enrollee transitioning from one treatment setting to another, or experience transitions due to level of care changes, PBDRx will provide a supply of medication pursuant to CMS requirements in compliance with transition and continuity of care provisions.
More information: Plan Transition Process
You cannot be in more than one Part D plan at a time. If you are enrolled in another Part D plan when it comes time for enrollment with PBDRx, CMS will automatically disenroll the you from your other Part D plan or Medicare Advantage Prescription Drug (MA-PD) plan.
Appeals, Complaints, Redeterminations
If you have a complaint, dispute or level of dissatisfaction with Pharmacy Benefit Dimensions or one of our affiliated providers, or if you disagree with a coverage decision we have made, you will find assistance here.
Mail: Pharmacy Benefit Dimensions
Pharmacy Department
511 Farber Lakes Drive
Buffalo, New York 14221
Fax: (716) 580-5264
E-mail: pbdmedicareservicing@pbdrx.com
Contact PBDRx to ask for an initial coverage decision for a formulary, tiering, or utilization restriction exception. When you request a formulary, tiering, or utilization restriction exception, you should submit a statement from your provider supporting your request.
To request an exception, please call our Member Services Department or send us a Drug Coverage Determination Form.
Sometimes, you may have difficulty getting the drugs you need. That’s why you have the right to request a coverage determination and get a written explanation from your Medicare drug plan if:
- Your prescriber or pharmacist tells you that your Medicare drug plan will not cover a drug in the amount or form prescribed.
- You are asked to pay a different cost-sharing amount than you think you are required to pay for a prescription drug.
You also have the right to ask your Medicare drug plan for an exception – a special type of coverage determination – and get a written explanation from your Medicare drug plan if:
- You believe you need a drug that is not on your plan’s list of covered drugs.
- You believe a coverage rule (such as prior authorization or a quantity limit) should not apply to you for medical reasons.
- You believe you should get a drug you need at a lower cost-sharing amount.
For more information on coverage determinations, refer to chapter 6 of the Evidence of Coverage (EOC) for your Prescription Drug plan.
An appeal is the type of complaint you make if you disagree with a drug coverage decision we have made.
To appeal, complete the Redetermination Form within 65 days of the initial coverage decision and mail or fax it to Pharmacy Benefit Dimensions. For more information on complaints and appeals, please refer to your Evidence of Coverage (EOC) for your Prescription Drug plan.
If you have a grievance, which is any complaint, dispute, or level of dissatisfaction you may have with Pharmacy Benefit Dimensions or one of our affiliated providers you may print and fill out the Member Complaint Form and mail, email, or fax it to Pharmacy Benefit Dimensions. You may also file a complaint directly with Medicare.
Medicare Financial Assistance
If you are new to Medicare, are looking for information on a new Medicare plan, or would like to know whether you are eligible for Medicare financial assistance, visiting these sites may help.
The Medicare Prescription Payment Plan (M3P) is a payment option that works with your current drug coverage to help you manage your out-of-pocket Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage can use this program.
All Pharmacy Benefit Dimensions Medicare plans offer this option. Participation is voluntary and all members are eligible.
To opt in to the program, please log in to your PBDRx account.
You can download a copy of the official Medicare handbook, “Medicare & You,” or request that a copy be sent to you. To access this resource, visit Medicare’s website.
Medicare Cost Payment Assistance: These agencies may be able to offer help in paying for your Medicare costs.
Drug Management and Safety
Helping You Safely Manage Your Prescriptions
Pharmacy Benefit Dimensions strives to provide safe access to your medications while addressing any specific safety concerns. Through Drug Utilization Review and Medication Therapy Management, we are here to support your health, safety, and peace of mind.
MTM is a personalized service designed for Medicare Part D members with complex medication needs. The goal is simple: make sure your medications are safe, effective, and work together the way they should. If you qualify, you’ll receive a one-on-one medication review with an expert pharmacist at no cost to you.
Get Started Today: Schedule an Appointment
Medicare Privacy, Fraud, Waste, and Abuse
Protecting your personal information is the best line of defense in the fight against healthcare fraud and abuse. Use the following tips to help you identify fraud, waste, and abuse and keep your health information safe.
Take these three steps to keep yourself safe from identity theft:
- Don’t provide your personal information (e.g., your Medicare, Medicaid or Social Security numbers) to anyone except your doctor, health plan or Medicare approved provider. You can check if a provider is Medicare approved by calling 1-800-MEDICARE (1-800-633-4227) (TTY: 711).
- Keep a personal health care journal or calendar to record your doctor visits, tests and procedures.
- Save and review your Medicare Summary Notices and Part D Explanation of Benefits.
Make a confidential report by contacting Independent Health’s Special Investigations Unit (SIU) at 1-800-665-1182 (TTY: 711) from 8:30 a.m. – 3 p.m. Monday – Friday
- Or by e-mail at:
SIU@independenthealth.com - Or contact Medicare at
1-800-633-4227
(TTY: 711)
Keep a watchful eye out for any doctors or health care providers who:
- Ask for your Medicare number in exchange for free equipment or services, or for “record keeping purposes.”
- Tell you that the more tests that are provided the cheaper they are.
- Advertise “free” consultations to people with Medicare.
- Call or visit you and say they represent Medicare or the federal government – Medicare will not call or visit your home.
- Use telephone or door-to-door selling techniques.
- Use pressure or scare tactics to sell you expensive medical services or diagnostic tests.
Monitor your billing statements and review your medical records for potential errors, such as:
- Charges for prescriptions or services you didn’t receive.
- Double billing for the same prescription or service.
- Ask your provider whenever you:
- Don’t understand your billing statement.
- Are not sure if you received a service that is listed.
- Feel a service your provider is recommending is unnecessary.
Think you may have a billing error? Contact Medicare Servicing
Rights and Responsibilities
As a Medicare member, you have specific rights and responsibilities that ensure you receive fair treatment and access to necessary healthcare services.
Upon your disenrollment from the plan, Pharmacy Benefit Dimensions must:
- Provide you with an acknowledgement and confirmation of disenrollment notice.
- Provide you with a denial of or rejection by CMS of disenrollment, if applicable.
- Inform you about Medigap rights during a special enrollment period.
- Provide advance notice in the event you are involuntarily disenrolled and explain reasons for disenrollment.
- Provide advance notice in the event your enrollment in a Prescription Drug Plan is ending.
- If you do not stay continuously enrolled in Medicare Part A & Part B.
- If you move out of our service area.
- If you are away from our service area for more than six months in a row.
- If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Member Services are located in the right column.)
- If you have been a member of our plan continuously since before January 1999 and you were living outside of our service area before January 1999, you may continue your membership. However, if you move and your move is to another location that is outside of our service area, you will be disenrolled from our plan.
- If you become incarcerated (go to prison).
- If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
- If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
- If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
- If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.) If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
- If you do not pay the plan premiums for 90 days. We must notify you in writing that you have 90 days to pay the plan premium before we end your membership.
- If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.
If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.
- You must make a written request for disenrollment prior to the 1st of the month in which disenrollment is intended.
- Please contact your group administrator to understand when you may be able to disenroll from your plan.
- You will be advised that upon disenrollment from a Part D plan, that unless you obtain another Part D plan, or otherwise elect another type of creditable prescription drug coverage, that you may be subject to a Late Enrollment Penalty should a lapse in coverage occur for 63 or more days.
- You will be reminded that if you do not enroll in another Medicare Advantage Plan or Medicare Advantage Plan with Prescription Drug coverage, that you will be enrolled in Original Medicare.
Email Us
Pharmacy Benefit Dimensions Member
pbdmedicareserving@pbdrx.com
Independent Health Member
medicare.help@independenthealth.com
Call Us
1-800-667-5936 or (716) 504-4444
(TTY users call 711)
Monday - Sunday, 8 a.m. - 8 p.m. ET
(Oct. 1 - Mar. 31)
Monday - Friday, 8 a.m. - 8 p.m. ET
(Apr. 1 - Sep. 30)
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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.
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Last Updated 1/1/2026