Pharmacy Resources and Benefit Forms

You are viewing services for 2022 Medicare Advantage Coverage

View 2021 Medicare Advantage for this page

Speak with a Medicare Advantage advisor at (866) 350-2715

Navigate the pharmacy benefit related forms and resources (Part D) on this page. Additional plan documents can be found at the Resource Center.

Resources

Pharmacy Directories

Here at Memorial Hermann Advantage we strive to provide our members with the most accurate Pharmacy Directories. If you need help finding a network provider, please call customer service: (855) 645-8448 (TTY 711).

Or click here to access our online searchable directory. If you would like a Pharmacy Directory mailed to you, you may call the number above, or request one here.

View all of our plan’s 2022 pharmacy directory by visiting the Pharmacy Directory page.

Aquí en Memorial Hermann Advantage nos esforzamos por ofrecer a nuestros miembros los Directorios de Farmacias más precisos. Si necesitas ayuda para encontrar un farmacia dentro de la red, llama al: (855) 645-8448 (TTY 711).

O visita aquí para acceder a nuestro directorio de búsqueda online. Si deseas recibir por correo un Directorio de Farmacias, puedes llamar al número indicado más arriba o solicitar uno en el sitio web aquí.

Visite la pagina de Directorios de Farmacia para ver todos nuestros directories para el 2022.

Drug List

Comprehensive Formularies

For plans (Memorial Hermann Advantage HMO, Memorial Hermann Advantage Jefferson HMO, and Memorial Hermann Dual Advantage (HMO D-SNP), please view our HMO formulary or drug list on our Formulary page.

For Memorial Hermann Advantage Plus HMO plan, please view our HMO Plus formulary or drug list on our Formulary page.

The Formulary may change at any time during the year. You will receive notice when necessary.

Formulary Restrictions

You may see a list of prescription drugs on the formulary that has a Prior Authorization or Step Therapy restrictions by visiting our Formulary page.

Costco Mail Order Information and Forms

If you take a "long-term" medication, consider enrolling in Costco Mail Order Pharmacy services. There are two options available to you: traditional mail order or online enrollment. For more information on home delivery (mail order) information, please visit the Costco Mail Order section of the Pharmacy FAQ page.

To enroll in traditional mail order services, please see the forms below.

Mail-Order Form (English) Mail-Order Form (Spanish)

For more information, please reach out directly to Costco Mail Order Pharmacy at (800) 607-6861 or click here.

For instructions on how to enroll for prescriptions online with Costco Mail Order, click here.

Navitus Member Portal

This private, secure website is designed just for you. All of your pharmacy plan information is available and kept up-to-date in real time.

Easy access allows you to:

  • Manage all your prescriptions on a single dashboard
  • Compare prices at local pharmacies
  • Find your lowest prescription cost
  • Locate your pharmacy and get driving directions
  • Keep track of your health history
  • Learn more about your drugs
  • Take it all with you through the mobile app
  • And much more.

Visit https://members.navitus.com/ and use your member ID number to register. Questions? Call Navitus Customer Service at (866) 270-3877. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).

Navitus Mobile App

The mobile app provides easy, on-the-go access to your personalized health information. Once you have your member ID number, download the app to take advantage of the benefits your pharmacy plan offers. Managing your prescription medications is a key part of managing your health. Take your medication information with you wherever you are with the mobile app. Download now for iOS and Android devices. (Please note that by clicking on this link, you will be leaving Memorial Hermann website).

For Mobile App Account Assistance Contact Customer Care, please call customer service at (844) 268-9789.

Navitus QR Code

Prescription Drug Reimbursement Form

Our plan allows for reimbursements of certain claims. Please download the form below, complete it and follow the submission directions.

Member Reimbursement Drug Claim Form 2022 (English) / (Spanish)

Mail this form along with receipts to:
Memorial Hermann Health Plan Manual Claims
C/O Navitus Health Solutions, LLC
Member Reimbursement Department
P.O. Box 1039
Appleton, WI 54912-1039
Or Fax this form along with receipt to: Toll Free (855) 668-8550

Additional Plan Documents and Resources

Additional plan documents and resources can be found in the Resource Center if you need more help finding a plan documents or pharmacy benefit related documents, please call customer service: (855) 645-8448 (TTY 711).

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