2018 Annual Notice of Changes and Evidence of Coverage

2018 Summary of Benefits

2018 Multi-Language Insert

2018 Formulary, Provider, and Pharmacy Directory Notice

Plan Ratings Document

Tribute Part D Coverage Determination Form

Tribute Part D Redetermination Form

Medication Transition Policy

This process has been put in place to aid our members in managing their drug coverage when transitioning from one plan to another where a certain medication may not be covered by our plan.

Medication Therapy Management Program

Aids our members with the more complex medication needs such as multiple medications or chronic medical condition.

2018 Comprehensive Formulary (Updated 10/2018)

2018 Formulary Changes (Updated 10/2018)

2018 Prior Authorization (Updated 10/2018)

Many medications offered through Tribute require prior authorization to ensure for appropriateness and medical necessity. The link above will show the various categories of drugs requiring prior approval

2018 Step Therapy (Updated 10/2018)

Some medications require other medications to be used prior to another prescription. The link above indicated applicable medications.

2018 Quantity Limit (Update  10/2018)