Pharmacy Resources and Benefit Forms

This page helps our members and providers navigate the Medicare Part D benefit offered through Memorial Hermann Advantage HMO plans.

Questions? Contact Customer Service at (855) 645-8448

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.

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.

2021 Pharmacy Directory

Formulary

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

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 to 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

Contact Us

For more information on your pharmacy benefits, contact Navitus Customer Service at (855) 645-8448.

Part D Materials

Part D Transition Policy
This transition policy applies to Part D medications and ensures a smooth transition for new Memorial Hermann Advantage members.

To request coverage for a non-formulary drug, a quantity limit exception, a step therapy exception or drugs requiring prior authorization, please download the Request for Coverage Determination Form.

HMO   Plus HMO

HMO   Plus HMO

Low-Income Subsidy (LIS) or Extra Help

To view more information on Extra Help or Low-Income Subsidy (LIS) premium summary chart, please visit Extra Help or Low Income Subsidy page.

Member 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 2021

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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