Colorado Medicare Part D Prescription Drugs

Choosing Part D coverage from RMHP is an excellent choice.  Because we are a not-for-profit organization, we concentrate on providing advantages such as:  

Late Enrollment Penalty

If you delay enrollment in 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 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.

Formulary

The Premier Formulary (Español) is a comprehensive list of all prescription drugs covered under RMHP Colorado Medicare Plans for 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 here (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

Step Therapy

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.

Prior Authorization

Some RMHP Medicare Part D drugs require prior authorization before coverage.

If you need a drug from the Prior Authorization List, your physician must complete a Preauthorization Form before your drug will be covered.

Participating Pharmacies

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

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 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.

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
Customer Service
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.

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 appeals processes.

Access the Medicare Prescription Drug Determination Request Form:
Form for Enrollees

Form for Providers

View a copy of the Formulary Exception Request Form, used by physicians to send supporting statements for exception requests:

Non-Covered Part D Drug Request Form