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  • Part D Coverage

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.
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  • Part D Coverage

Complaint and Appeals Form (ESP -Español)

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  • Part D Coverage

Complaint and Appeals Form

Complaint an Appeals Form for filing an appeal for Part D Prescription Drugs.
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  • Part D Coverage

Medicare Prescription Drug Determination Request Form

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  • Part D Coverage

Coverage Determination Request Form (ENG)

  • Document
  • Part D Coverage

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).
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  • Part D Coverage

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.
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  • Part D Coverage

MedImpact Direct Frequently Asked Questions

You can download the Frequently Asked Questions (FAQ) for MedImpact Direct Here. This resource may assist when registering for the MedImpact Direct Mail® Program.
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  • Part D Coverage

MedImpact Direct Order Form

If registering for Mail Order with MedImpact, you can download their Direct Order Form here.
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  • Part D Coverage

Mail Order

Learn more about the MedImpact Direct Mail® Program and Birdi™.
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  • Part D Coverage

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.
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  • Part D Coverage

Step Therapy

Learn more about Step Therapy.
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  • Community Resources

Medicare Advantage vs. Original Medicare: Which Fits Your Life?

A plain-language comparison of Medicare Advantage and Original Medicare, covering costs, provider choice, prescription coverage, extra benefits, and key questions to consider when choosing or changing coverage.
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  • Health Topics

Managing Multiple Health Conditions: A Guide to Coordinating Your Care

Practical guidance for older adults and caregivers managing multiple health conditions, including tips for organizing medications, appointments, treatment plans, and communication across the healthcare team.
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  • Health Topics

Colorectal Cancer Screening After 65: What to Know

A simple guide to colorectal cancer screening after 65, including common testing options, recommended intervals, what to expect, and questions to discuss with your healthcare provider.
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  • Health Topics

Kidney Health After 65: What to Watch For and How Champion Supports You

Learn about chronic kidney disease risk factors after age 65, why early kidney disease can be difficult to detect, and when to talk with your healthcare professional about routine testing.
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  • Community Resources

Heart Disease 101: Warning Signs You Should Know About

A simple guide to heart disease risk factors and warning signs, plus practical steps you can take to support cardiovascular health and know when to seek medical attention.
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  • Health Topics

Living Well with Diabetes: A Guide to Daily Management

Practical tips for managing diabetes day to day, from tracking blood sugar and planning balanced meals to taking medications as prescribed and staying connected with your healthcare team.
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  • Health Topics

Staying Active with Diabetes: Exercise Tips That Won’t Spike Your Blood Sugar

Practical tips for staying active with diabetes, including how to prepare for exercise, monitor blood sugar, stay safe during activity, and recognize how exercise can affect your glucose levels.
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  • Community Resources

Transplant Living

Transplant resources from the United Network for Organ Sharing (UNOS), the organization that maintains the U.S. organ transplant waiting list.
  • External Link