The prescription drugs your D-SNP covers are shown in a formulary, also called a Drug List. Your formulary shows which Medicare Part D prescription drugs are covered under your Medicare Part D benefits. It also stays updated with any drug restrictions.
Our Medication Therapy Management (MTM) Program is a no cost program that helps our members get the most out of their medication. If you choose to join the MTM program, a pharmacist or other health professional will review all your medications, then talk with you about:
You’ll also get a written summary with next steps if needed.
We want you to be safe when you take your medicine. That's why we have quality assurance programs and policies to check your prescriptions. Here's what our quality assurance includes:
Your D-SNP prescription drug benefits includes both Medicare Part D and Medicaid prescription drug coverage. When you doctor writes a prescription, your drug coverage offers:
Remember to show your membership card each time you visit your pharmacy.
Highmark Wholecare follows rules about your prescription drugs, especially ones given in a doctor's office. Sometimes you might need to try a preferred medicine first before we cover a nonpreferred one. This is called step therapy. We may also need you to get approval ("prior authorization") before we cover certain medicines.
Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Medicare Ombudsman Website
Best Available Evidence
Y0037_1359_M_2026
Last Updated: April 3, 2026
