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Part D Coverage

Prescription drug coverage information for Champion Health Plan members.

Plan Year

State

Language

Plan Name

On this page

  • 2027
  • CA, NV
  • ENG (English)

2027 Step Therapy Criteria Form

Effective January 1st, 2027.
  • Document

Last Modified Date:

  • October 20, 2026
  • 2027
  • CA, NV
  • ENG (English)

2027 Prior Authorization Criteria

  • Document

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Medicare Prescription Drug Determination Request Form

  • Document

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Personal Medication List (Sample)

If enrolled in the Medication Therapy Management Program, you will have be provided with a Personal Medication List once you complete the review session. You can view a Sample Personal Medication List here.
  • Document

Last Modified Date:

  • October 20, 2026
  • 2026
  • CA, NV
  • ENG (English)

2026 Step Therapy Criteria Form

*Note: Step Therapy Criteria Form is updated on a monthly basis.
  • Document

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Step Therapy

Learn more about Step Therapy.
  • Article

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Medicare Prescription Payment Plan (English)

  • Document

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ESP (Español)

Medicare Prescription Payment Plan (Spanish)

  • Document

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December).
  • Article

Last Modified Date:

  • October 20, 2026
  • 2026
  • CA, NV
  • ENG (English)

2026 Prior Authorization Criteria

*Note: Prior Authorization Criteria Form is updated on a monthly basis.
  • Document

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Prior Authorization, Coverage Determination, and Exceptions

A coverage determination is any determination (i.e. an approval or denial) made by Champion Health Plan regarding your Medicare Part D prescription drug coverage. Learn more about what your requests for Part D coverage determination may include.
  • Article

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Prior Authorization Look Up Page

Prior Authorization Look Up Codes
  • Internal Link

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Mail Order

Learn more about the MedImpact Direct Mail® Program and Birdi™.
  • Article

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Medication Therapy Management Program (MTMP)

Learn more about our Medication Therapy Management Program today – Champion Health Plan’s free voluntary program for members who have multiple medical conditions, take many prescription drugs, have high drug costs, and/or are determined to be at risk for misuse or abuse of an opioid or a frequently abused drug under our Drug Management Program (DMP).
  • Article

Last Modified Date:

  • October 20, 2026
  • 2026, 2027
  • CA, NV
  • ENG (English)

Extra Help (Medicare Part D)

Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage.
  • Article

Last Modified Date:

  • October 20, 2026
  • 2027
  • CA

Find a Pharmacy – 2027 – California – COMING SOON

  • External Link

Last Modified Date:

  • October 20, 2026
  • 2027
  • NV

Find a Pharmacy – 2027 – Nevada – COMING SOON

  • External Link

Last Modified Date:

  • October 20, 2026
  • 2027
  • CA, NV
  • ENG (English)

2027 LIS (Low Income Subsidy) Chart

Monthly Plan Premium Information for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs
  • Article

Last Modified Date:

  • October 20, 2026
  • 2027
  • CA
  • ESP (Español)

2027 Covered Medication List (Formulary) – California (Spanish)

Effective January 1st, 2027.
  • Document

Last Modified Date:

  • October 20, 2026
  • 2027
  • CA
  • ENG (English)

2027 Covered Medication List (Formulary) – California (English)

Effective January 1st, 2027.
  • Document

Last Modified Date:

  • October 20, 2026