Medicare Part D Plans in Colorado
Medicare Prescription Drug coverage
Choosing Medicare Part D plans from Rocky Mountain Medicare is an excellent choice. We are a Colorado-based, Member focused, community health plan and we concentrate on providing advantages such as: An extensive formulary of covered medications A large number of participating pharmacies throughout the state and nationwide High quality, Colorado-based customer service from our headquarters located in Grand Junction The convenience of dealing with one company for all your benefits needs or questions.
The 2017 Premier Formulary | Spanish (2016 Premier Formulary | Spanish )is a comprehensive list of all prescription drugs covered under Rocky Mountain Medicare Cost Plans with Part D. It also explains the copayment or tier level applicable to the drugs you take (for example: Tier 1, Tier 2, Tier 3, etc.) and any quantity limitations that may apply.
If your current prescription drugs are not on the formulary or are limited, you can learn about RMHP's Prescription Drug Transition Process (2016) English | Español; (2017) English | Español;
RMHP provides 60-days’ notice regarding removal or change in the tier level applicable to the drugs on the formulary. These changes are listed on RMHP’s Formulary Change Notice.
Enhanced Formulary (For PERA Members Only) 2017
Enhanced Formulary (For PERA Members Only) 2016
The RMHP Medicare Provider Directory includes the list of contracted pharmacies that you must use to receive RMHP Part D drug benefits.
- 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 Medicare Part D coverage
- Most of our network pharmacies supply 90 day prescriptions
You can get a 30-day supply of your drugs at all contracted retail pharmacies. The RMHP Medicare Provider Directory also contains information on retail pharmacies that can provide a 90-day supply of your prescription. (Residents of long-term care facilities are able to get a 31-day supply of medications from the long-term care facility’s pharmacy).
Generally, you must use a contracted pharmacy to receive covered Medicare Part D drugs. However, covered Rocky Mountain Medicare 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 and restrictions may apply. In addition to paying the copayments/coinsurances, you will be required to pay the difference between what RMHP would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescriptions.
Part D Benefits Grid
For Customer Service: call 8:00 a.m. to 8:00 p.m., Mountain Time, (from October 1 - February 14, 7 days per week; from February 15 - September 30, M-F) at 970-244-7912 or 888-282-1420 (TTY: 711). Para asistencia en español llame al 888-282-1420.
You can also write to:
Rocky Mountain Health Plans
PO Box 10600
Grand Junction, CO 81502
Mail Order Pharmacy
You can use a contracted mail order pharmacy to have a 90-day supply of your prescriptions mailed directly to your home.
In some cases, you may be required to first try certain drugs to treat your medical condition before another drug will be covered for that condition.
Review the list of drugs that require:
Step Therapy for 2016
Step Therapy for 2017
Some RMHP Medicare Part D drugs require prior authorization before coverage.
Review the list of drugs that require:
Prior Authorization for 2016
Prior Authorization for 2017
Medication Therapy Management (MTM)
RMHP offers a Medication Therapy Management (MTM) program to assist Members in optimizing effectiveness of prescription drugs at no cost to you.
Complaints, Coverage Determinations and Appeals
Review a Summary of the RMHP grievance, coverage determination (including exceptions), and re-determinations
Access the Medicare Prescription Drug Determination Request Form:
Form for Enrollees
Form for Providers
Access the Medicare Prescription Drug Redetermination Request Form
To request coverage of a medication (e.g. Prior Authorization, Formulary Exception, Tier Exception, Step Therapy Exception, Quantity Limit Exception) complete the electronic Medicare Medication Request Form: Electronic Medicare Part D Medication Request Form
For information on how to file or check on the status or process of an appeal, or to obtain an aggregate number of grievances, appeals, and exceptions filed with Rocky Mountain Health Plans, call customer service department at 888-282-1420 (TTY dial 711). Hours are 8am - 8pm, & days/week, Oct. 1-Feb.14, and 8am – 8pm, M-F, Feb 15-Sept 30.
Late Enrollment Penalty
If you delay enrollment in Medicare Part D you may incur a late enrollment penalty. The cost of the late enrollment penalty varies based on the length of time that you went without creditable Part D -drug coverage.
Some individuals may qualify for Extra Help and may not be subject to late enrollment penalties. To find out if you qualify for Extra Help call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-352-0778; or your state Medicaid Office.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
This information is available for free in other languages. Please call our Customer Service number at 888-282-1420 (TTY dial 711). Hours are 8am - 8pm, 7 days/week, Oct. 1–Feb.14, and 8am - 8pm, M-F, Feb.15–Sept.30. Esta información está disponible gratuitamente en otros idiomas. Por favor llame a la línea de Atención a Clientes, al 888-282-1420 (TTY marque 711). Horario de 8am - 8pm, 7 días a la semana, del 1 de octubre al 14 de febrero; y de 8am - 8pm, de lunes a viernes, del 15 de febrero al 30 de septiembre.
This page was last updated: 10/01/16. Please call to confirm you have the most up to date information about our Medicare Cost plans. Medicare Disclaimers
RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. H0602_MS_MC500WEB_RMHP1 Pending CMS Review.