About Part D Coverage
Rocky Mountain Health Plans (RMHP) offers coverage for Medicare beneficiaries looking for Part D prescription drug benefits from a strong and stable company you can trust.
We have served Colorado residents since 1977 under a contract with the Centers for Medicare & Medicaid Service (CMS), the provider of original Medicare benefits. RMHP is a Medicare approved Part D sponsor. Choosing to receive your Medicare Part D benefits through RMHP is an excellent Medicare choice. Wherever you live in Colorado, we provide Part D services.
Because RMHP is a not-for-profit organization, we are able to concentrate on serving our Members and offering other advantages such as:
- Extensive formulary
- Large list of participating pharmacies throughout the State
- Colorado-based Customer Service located in Grand Junction
Formulary
Click here for a Green Plan + Rx (Cost), Thrifty Plan + Rx (Cost), Standard Plan + Rx (Cost), or Gold/Plus Plans + Rx (Cost) formulary to see the comprehensive list of prescription drugs covered.
Click here for Essential Rx Plan (PDP) Stand Alone Part D plan formulary, to see the comprehensive list of prescription drugs covered.
Click here to see a list of Part D drugs that require prior authorization.
The formulary will also explain the copayment or tier level applicable to the drugs you take (for example: generic, preferred brand, non-preferred brand), and any quantity limitations that may apply to your drugs.
RMHP is required to provide 60-day notice regarding removal or change in the tier level applicable to the drugs on the formulary.
Click here to see RMHP’s Formulary Change Notice.
What if my current prescription drugs are not on the formulary or are limited on the formulary? Click here to learn more about Rocky Mountain Health Plan's prescription drug Transition Process.
In some cases, RMHP requires you to first try certain drugs to treat your medical condition before another drug will be covered for that condition. Click here to see Drugs Requiring Step Therapy.
Participating Pharmacies
Click here to see the Pharmacy Directory the list of contracting pharmacies that you must use for the RMHP Part D drug benefits.
This document will give you more information about:
- The number of pharmacies in the network
- The pharmacy addresses and phone numbers
- The types of pharmacies that you may utilize to access your prescription drugs through RMHP Part D plans
Generally, you must use a contracting pharmacy to receive covered Part D drugs. However, covered Part D drugs are available at out-of-network pharmacies in special circumstances including illness while traveling outside of the plan's service area where there is no network pharmacy. You are limited to a 30 day supply when you receive a prescription from an out-of-network pharmacy.
RMHP has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.
In addition to paying the copayments/coinsurances, you will be required to pay the difference between what we would pay for a prescription filled at an in-network retail pharmacy and what the out-of-network pharmacy charged for your prescriptions. You can get a 30 day supply of your drugs at all contracting pharmacies. The pharmacy directory will also give you more information on which retail pharmacies you can use to get a 90 day supply of your prescription. (Residents of a long-term care facility are able to get a 31 day supply of their medication from the long-term care facility's pharmacy).
For additional, network pharmacy information, call Customer Service. We are open 8:00 a.m. to 5:00 p.m., Mountain Time, Monday through Friday.
- RMHP Members residing in Colorado, call 970-244-7912 or 888-282-1420.
- If you are hearing impaired and use TTY equipment, call 800-704-6370.
- Para asistencia en español llame al 888-282-1420.
For Part D prescription drug benefit questions, please call between 8:00 a.m. to 8:00 p.m., Mountain Time, Monday through Friday. From November 15 through March 1, we are also available 8:00 a.m. to 8:00 p.m., Mountain Time, on weekends and most holidays.
You can also write to:
Rocky Mountain Health Plans
Customer Service
PO Box 10600
Grand Junction, CO 81502
Mail Order Pharmacy
You can use a contracting mail order pharmacy to have a 90 day supply of your prescriptions mailed directly to your home. If you are interested in using the mail order pharmacy,
click here to receive more information.
Extra Help
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly prescription drug premiums, annual deductible, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. many people are eligible for these savings and don't even know it. For more information about this Extra Help, contact 1-800-MEDICARE (TTY/TDD users should call 877-486-2048) 24 hours/day, 7 days/week. You can also call your State Medicaid Office or the Social Security Administration at 1-800-772-1213 or on the toll free TTY/TDD number, 1-800-325-0778, between 7 a.m. and 7 p.m. Monday through Friday.
If you have qualified for additional assistance for your Medicare Prescription Drug Plan costs, the amount of your premium and cost at the pharmacy will be less. Once you have enrolled in a RMHP Part D Plan, Medicare will tell us how much assistance you are receiving, and we will send you information on the amount you will pay.
If you believe you qualify for extra help with your Medicare prescription drug costs, you may provide evidence to RMHP so that your costs will be reduced.
Click here to find out more information on Medicare's policy about submitting "best available evidence" (BAE).
Click here to see the Premium Summary Table for those receiving extra help:
Additional Information Available to Beneficiaries
There is additional information available to Medicare beneficiaries about RMHP Medicare Part D Plans:
Click here to see the copy of the Preauthorization Form physicians use to preauthorize your prescription drugs.
Click here to see the Medicare Prescription Drug Determination Request Form:
Click here to see the copy of the Formulary Exception Request Form used by physicians to send supporting statements for exception requests:
Medication Therapy Management
RMHP offers Medication Therapy Management programs to our Members. Medication Therapy Management programs (MTM) are available to all Medicare Part D Members who meet the limited criteria and are designed to assist Members in optimizing their medication therapies. This program combines the services of RMHP clinical pharmacists and Colorado registered pharmacists with medication data from Rocky Mountain Health Plans and is provided at NO CHARGE to our Members. MTM services are voluntary and the program is not considered a benefit of your plan. Contact RMHP Customer Service for additional information.
Complaints, Coverage Determinations and Appeals
To see a summary of the RMHP grievance, coverage determination (including exceptions), and appeals process,
click here.
Call Rocky Mountain Health Plans Customer Service for information on how to file or check on the status of an appeal. We are open 8:00 a.m. to 5:00 p.m., Mountain Time, Monday through Friday.
- RMHP Members residing in Colorado, call 970-244-7912 or 888-282-1420.
- If you are hearing impaired and use TTY equipment, call 800-704-6370.
- Para asistencia en español llame al 888-282-1420.
For Part D prescription drug benefit questions, please call between 8:00 a.m. to 8:00 p.m., Mountain Time, Monday through Friday. From November 15 through March 1, we are also available 8:00 a.m. to 8:00 p.m., Mountain Time, on weekends and most holidays.
If you wish to authorize another individual to make requests, obtain information or present information to us on your behalf, you must complete the Appointment of Representation Form and send it to PO Box 10600, Grand Junction, CO 81502.
To obtain an aggregate number of the Plan's grievances, appeals, and exceptions please call Rocky Mountain Health Plans Customer Service.
Information is available in alternative formats and languages.
Se puede presentar la informacion acerca del plan en un formato o idioma distinto. Para solicitar un documento en español, favor llamar a Atención al Cliente, al numero telefónico indicado debajo.
Contact Customer Service for more information. We are open 8:00 a.m. to 5:00 p.m., Mountain Time, Monday through Friday.
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RMHP Members residing in Colorado, call 970-244-7912 or 888-282-1420.
-
If you are hearing impaired and use TTY equipment, call 800-704-6370.
-
Para asistencia en español llame al 800-346-4643.
For Part D prescription drug benefit questions, please call between 8:00 a.m. to 8:00 p.m., Mountain Time, Monday through Friday. From November 15 through March 1, we are also available 8:00 a.m. to 8:00 p.m., Mountain Time, on weekends and most holidays.