Colorado Medicare Part D Prescription Drugs

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

  • An extensive formulary
  • A large number of participating pharmacies throughout the State
  • High quality, Colorado-based customer service from our headquarters located in Grand Junction
  • Late Enrollment Penalty

    If you delay enrollment in Colorado 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 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 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  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)

    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 (2014).

    Prior Authorization

    Some RMHP Colorado 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 Colorado 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:

    Tier Exception Request Form

    Non-Covered Part D Drug Request Form

    RMHP's contract with Medicare is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed. RMHP has contracted with Medicare to provide benefits since 1977.
     
    This page was last updated: 07/21/2014. Please call to confirm you have the most up to date information about our Medicare Plans.  Privacy Notice and Listing of Medicare Disclaimers
     
    RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal.
    H0602_MS_MC200WEB_07212014 Pending

     

    For Customer Service Call:

    970-244-7912 or 888-282-1420 (TTY: 711).

    Available:

    8 a.m. to 8 p.m., Mountain Time.

    Oct. 1- Feb. 14- Open 7 days per week.

      Feb. 15- Sept. 30- Open M-F.

        Para Asistencia en Español:

        Llame al 888-251-1330.


        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 RMHP, 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.

        Medicare Formulary Search