Our formulary is our list of covered generic and brand-name prescription drugs for plans that have prescription drug coverage To view the formulary you can:
If you do not see the drug you are looking for in the formulary, please call our pharmacy customer service. We may cover that drug.
With this tool you can:
If you’re a current Summit Medicare Advantage member, please access the online benefit tool for prescription drugs through your Summit Member Dashboard for a more accurate cost estimate that accounts for your personal claims.
*Prescription drug information displayed on the online benefit tool is subject to change without notice and is not a guarantee of benefits. Your coverage is based on your plan benefit and eligibility at the time of service. If you have copay assistance it may affect your deductible and/or your maximum out of pocket amount. Coverage and cost sharing may vary for preventive service.
Summit Health covers the following preferred diabetic devices and supplies.
Please refer to your Evidence of Coverage (EOC) for your benefits and plan rules.
|Device/supply** ;||Preferred manufacturer|
|Continuous Glucose Monitor (CGM)||Dexcom
**Diabetic devices and supplies are covered through your Part B (medical) Medicare benefits. There may be prior authorization requirements and quantity limits. “Preferred” products do not guarantee coverage. We will not cover other brands and manufacturers for Part B diabetic devices and supplies unless your provider tells us that a different brand is appropriate for your medical needs. However, if you are new to our plan and are using a different brand, we will continue to cover that brand for you for up to 90 days. During this time, you should talk with your doctor to decide what brand is medically appropriate for you after the 90-day period.
Please call our Summit Health Customer Service at 844-827-2355 (TTY users, please call 711). Customer Service is available to help you from 7 a.m. to 8 p.m., Pacific Time, seven days a week from Oct. 1 to March 31. After March 31, your call will be handled by our automated phone system on weekends and holidays. Weekend calls are forwarded to voicemail and returned the next business day.
If we make changes to a drug you are taking, we will send you a notice. We will also post any changes for our formulary, with dates, on this page.
To request a prescription drug coverage determination, redetermination, or prior authorization, see our pharmacy coverage determination.
Last updated Oct. 1, 2022