Formulary Information for 2024 New Jersey plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2024 FormularyFind a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2024 Pharmacies
All New Jersey plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreUpcoming Formulary Changes
Download PDFFormulary Information for 2024 Georgia plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2024 FormularyView your plan's 2024 Formulary
Clover Health Live Healthy (PPO) (026)
Clover Health Live Healthy Value (PPO) (045)
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2024 Pharmacies
All Georgia plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreUpcoming Formulary Changes
Download PDFFormulary Information for 2024 Pennsylvania plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2024 FormularyView your plan's 2024 Formulary
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2024 Pharmacies
All Pennsylvania plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreUpcoming Formulary Changes
Download PDFFormulary Information for 2024 South Carolina plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2024 FormularyView your plan's 2024 Formulary
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2024 Pharmacies
All South Carolina plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreUpcoming Formulary Changes
Download PDFFormulary Information for 2024 Texas plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2024 FormularyView your plan's 2024 Formulary
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2024 Pharmacies
All Texas plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreUpcoming Formulary Changes
Download PDFFormulary Information for 2025 New Jersey plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2025 FormularyFind a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2025 Pharmacies
All New Jersey plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreFormulary Information for 2025 Georgia plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2025 FormularyView your plan's 2025 Formulary
Clover Health Live Healthy (PPO) (026)
Clover Health Live Healthy Value (PPO) (045)
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2025 Pharmacies
All Georgia plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreFormulary Information for 2025 Pennsylvania plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2025 FormularyView your plan's 2025 Formulary
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2025 Pharmacies
All Pennsylvania plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreFormulary Information for 2025 South Carolina plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2025 FormularyView your plan's 2025 Formulary
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2025 Pharmacies
All South Carolina plans
Download PDFFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
Prior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreFormulary Information for 2025 Texas plans
Find out if your drugs are covered
Clover Health's comprehensive formulary lists covered brand name and generic drugs available for your health needs. Our formulary represents the prescription therapies believed to be necessary for a quality treatment program, and was designed by Clover in consultation with a team of healthcare providers.
Clover covers the drugs listed in our formulary as long as the drug is medically necessary and all plan rules are followed.
Use the plan’s “Real-Time Benefit Tool” (available through caremark.com or by calling Member Services). With this tool you can search for drugs on the “Drug List” to see an estimate of what you will pay and if there are alternative drugs on the “Drug List” that could treat the same condition. To access the tool, you will need to register an account through our pharmacy benefits manager, CVS Caremark, on the caremark.com portal.
Quick Tip: Check your Member ID card for your specific plan name
Search the 2025 FormularyView your plan's 2025 Formulary
Find a pharmacy
Our in-network pharmacies provide prescription drugs to members. In most cases, your prescriptions are covered only if they are filled at a network pharmacy or through our mail-order pharmacy service. We will fill prescriptions at non-network pharmacies under certain circumstances, as described in the Evidence of Coverage.
Interested in using mail-order pharmacy service, click here to learn more.
Search for 2025 Pharmacies
All Texas plans
Download PDFPrior Authorization Criteria
Download PDFStep Therapy Criteria
Download PDFMedication Therapy Management Program
Read MoreFormulary Details
Clover will cover certain drugs as long as members meet specific prior authorization criteria. Additionally, Clover will only cover some medications after the member has first tried other medications to treat their medical condition.
Patients with certain chronic conditions who take eight or more prescription medications may be eligible for our Medication Therapy Management (MTM) program, which works with members' doctors and pharmacists to help provide the greatest benefit from their medications.
Changes to our formulary
Clover may add or remove drugs from our formulary throughout the year. Here are some possible changes and ways that we’ll keep you informed.
We must alert members taking a certain drug if we make any of these changes:
- remove the drug from our formulary
- Add prior authorization for the drug
- Add quantity limits and/or step-therapy restrictions on the drug
- Move the drug to a higher cost-sharing tier
- If we're removing a drug from our formulary, we'll either notify affected members 30 days prior to making that change or notify them when they request a refill of that drug (at which time the member will also receive a 30-day supply of the drug).
- If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we'll immediately remove the drug from our formulary and provide notice to members taking that drug.
If your drug isn't included or requires a prior authorization
Call our partner in medication services, CVS Caremark, to discuss options,
Phone Number for PPO Plans:
1-855-479-3657
Phone Number for HMO Plans
1-844-232-2316
Submit an online Coverage Determination Form.
Download, fill out and fax a Prescription Drug Coverage Determination form available at Part D Coverage Determinations, Exceptions, Grievances, and Appeals.
You can also ask your doctor if there's an acceptable alternate medication covered under our formulary.
Related information
Prescription Drug Transition Policy
Part D Coverage Determinations, Exceptions, Grievances, and Appeals
Quality Assurance and Drug Management Program
Centers for Medicare and Medicaid Services (CMS): Best Available Evidence (BAE) Documentation
Medicare Prescription Payment Plan (M3P)
For more information about the BAE policy, contact our Customer Experience Team at 1-888-778-1478 (TTY/TTD 711) 8 am to 8 pm local time, 7 days a week.*
Prescription Reimbursement forms
Quick Tip: For an easy claim submission process and a faster claim decision turnaround time submit requests for reimbursement of member-paid prescriptions online via Caremark web portal (Caremark.com) and the Caremark mobile app (available for Android and Apple).
You're now leaving the Clover Health Website.
The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, please click Cancel.
Clover provider services uses a third-party website.
The form for submitting a provider service request is hosted on a non-Clover website. However, the requests are read and responded to by Clover. If you do not wish to submit a service request via a non-Clover website, please click Cancel.
Original Medicare
Traditional Medicare covers hospitals (Part A) and doctors (Part B), and you pay standard rates for services. You can go to any doctor, hospital or other provider that accepts Medicare patients anywhere in the country.
You can add drug coverage (Part D) by enrolling in a private "stand-alone" drug plan for an additional premium. You can buy separate Medigap insurance to cover some or most of the out-of-pocket costs of hospitals (Part A) and doctors (Part B).
We found multiple counties for your ZIP code.
Select your county: