Pharmacy Part D

Prescription Drug Coverage for Medicare Part D

As a member of CHRISTUS Health Medicare Complete or Medicare Plus you have prescription drug coverage for Medicare Part D in addition to medical and hospital benefits.

To see if CHRISTUS Health Plan covers a specific prescription drug, please search our downloadable, or online formulary below.

To keep costs low for members and reduce medication errors, we use utilization management practices and drug utilization reviews.


What is Utilization Management?

Utilization management is a practice where some medical services and drugs are evaluated for need before they can be used. This means that for certain prescription drugs, special rules restrict how and when the plan covers them. A team of doctors and pharmacists developed these rules to help members use drugs effectively and keep coverage affordable.

Examples of utilization management include:

Prior Authorization

We may require you to get approval from us before you fill certain prescriptions. If you don’t get approval, we may not provide coverage for the drug.

Downloadable List of Prescriptions that require a Prior Authorization per plan coverage year.

Quantity Limits

We may limit or only cover a certain amount of a drug per prescription or for a period of time.

Step Therapy

In some cases, members may need to try one drug to treat their condition before we will provide coverage for another drug.

Downloadable List of Prescriptions that are part of Step Therapy utilization per plan year.

Generic Substitution

When a generic version of a drug is available, our pharmacies will automatically give members that version unless your doctor has told us that you must take the brand name drug.

You can find out if your drug is subject to these additional requirements or limits by looking in our formulary. If your drug does have additional restrictions or limits, you can ask us to make an exception to our coverage rules.


What is a Drug Utilization Review?

During a drug utilization review, we check your prescriptions and look for problems like:

  • Possible medication errors
  • Duplicate drugs that are unnecessary
  • Drugs that are inappropriate because of your age or gender
  • Possible harmful interactions between drugs you are taking
  • Drug allergies or dosage errors

These reviews are especially important if you have multiple doctors who prescribe medications.

We conduct reviews each time you fill a prescription and on a regular basis. If we see a problem during our review, we will work with your doctor to correct it.


Formulary

A formulary is a list of prescription drugs covered by your CHRISTUS Health Medicare Complete Plan or Medicare Plus Plan.

The drugs on this list are selected by the CHRISTUS Health Plan with the help of doctors and pharmacists.

The formulary also provides a brief description of your coverage.

Below we provide you with a comprehensive formulary (a complete listing of covered drugs) plans and an abridged formulary (a partial listing of covered drugs) for your convenience to download.  Additionally, we offer you an online searchable version.  

Searchable Formulary

Medicare Complete

Medicare Plus

Downloadable Formulary

Express Scripts Mobile App

Medication Therapy Management Program

Medication Therapy Management (MTM) is a free service for members who take multiple medications for multiple health conditions.

Medication Therapy Management Program
Over the Counter Drug Program

Over the Counter Drug Program
Determination and Exceptions

A coverage determination is a decision made by CHRISTUS Health Plan regarding payment, dosage limits prior authorization and other matters with prescription drugs.

Determination and Exceptions

H1189_WEB25MM3012_M | Last Updated 2/5/25