Formulary

Learn which medications require authorization.

Individual Members

• Individual Commercial Formulary
   
  2012 Commercial Formulary
  (revised: 1/25/2012 1:41:30 PM)

Group Members

• 2012 Commercial Formulary
  (revised: 1/25/2012 1:41:30 PM)
• AvMed's Authorization Requirements & Processes 
• Commercial Rx Mail Order Form 
• Commercial Rx Health and Allergy Questionnaire
• 2012 2-Tier Preferred Medication List
  (revised: 1/25/2012 1:41:08 PM)

Medicare Members

• AvMed Medicare 2012 Comprehensive Formulary
• 2012 Part D Prior Authorization Criteria
• 2012 Part D Step Therapy Criteria
• AvMed's Authorization Requirements & Processes 
• Part D Quantity Limit Information
• Explanation of Part D Appeals (More Info)
  
  This document helps you find information on what an appeal is, how to file an appeal, time frames for filing and appeal, and how to contact us by telephone, fax, or mail. (Less info)
• Medicare Rx Mail Order Form
• Medicare Rx Health Allergy Questionnaire
• Medication Exception Request Form
• Quality Assurance: Drug Management Programs 
• Part D Transition Policy
• AvMed Medicare EOC 2012

For information on appointing a representative to assist you with your appeal and CMS form, "Request for Medicare Prescription Drug Determination", visit the Medicare website.

AvMed has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in Miami-Dade and Broward counties.

If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare may cover all or some portion of your prescription drug costs.  In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point.  To address these situations, CMS has created the best available evidence (BAE) policy that requires plans to accept appropriate documentation as evidence of establishing the accurate level of cost sharing the member should be paying.  Please use the link provided to learn more about this policy.

AvMed is here for you 24 hours a day, seven days a week. You can reach us by telephone at 1-800-782-8633 (TTY users, please call 1-877-442-8633, 8:00 AM - 8:00 PM), or you may write to us at: AvMed Health Plans, P O Box 569008, Miami, FL 33256.