Member Resources
Frequently Asked Questions
What if my drug is not on the formulary?
If your prescription is not listed on our formulary, you should first contact Customer Service to be sure it is not covered. If Customer Service confirms that we do not cover your drug, you have three options:
- Community CCRx can help you find another drug to treat your medical condition that is part of our formulary.
- You can ask us to make an exception and cover your drug.
- You can pay out of pocket for the drug and request that the plan reimburse you.
Click here to learn more about your options if your drug is not on the formulary.
How can I request an exception to Community CCRx's formulary?
You can ask us to make an exception to our coverage rules. Click here to access our process and form for filing an exception.
What is utilization management?
For certain prescription drugs, Community CCRx has additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for Community CCRx to help us to provide quality care to our members. For more information about examples of utilization management and how you can take advantage of this procedure, click here.
Your rights and protection under Community CCRx
Because you have Medicare, you have certain rights to help protect you. This section will enable you to access explanations of your Medicare rights and protections as a member of Community CCRx. We will tell you what you can do if you think you are being treated unfairly or your rights are not being respected. Please click here for complete explanations of your rights and protection under Community CCRx.