Your coverage includes an OTC benefit which provides coverage for everyday items you can buy without a doctor’s prescription. These include health and wellness items like vitamins, sunscreen, pain relievers, cough and cold medicine, and bandages.
Items can be ordered by phone or online through our participating provider and will be shipped directly to your home.
To learn more about your OTC benefit, including how much you have to spend, please refer to your Evidence of Coverage (EOC) or click on the Quick Reference Guide below.
With our mail order prescription services, we offer you a way to save time by getting your medications mailed right to your home! Get started today by completing and mailing the form below, or visiting the website on the request form.
Community Health Choice (HMO D-SNP) covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Members can contact the plan for a printed copy of the most recent list of drugs or view the link below.
The formulary may change throughout the year, you can call Member Services for the most current list.
If you are new to Community Health Choice (HMO D-SNP) and are taking a non-formulary drug, you are eligible for a temporary supply of your non-formulary drug. A non-formulary drug includes a drug that is not on Community’s formulary or a drug on the formulary that has special requirements. Our transition policy ensures that you can get a one-time temporary fill of at least one month’s supply* of the drug anytime during the first 90 days of your membership in Community Health Choice (HMO D-SNP). The prescription must be filled at a network pharmacy.
You and your doctor will receive a transition notice from us. This will allow you time to talk to your doctor or other prescriber about pursuing other options available to you within our formulary. Community Health Choice (HMO D-SNP) cannot continue to pay for these medications under the transition policy, even if you have been a member for less than 90 days following your one month transition supply.
*If your prescription is written for fewer days, you will be allowed to fill your drug multiple times to provide at least one month’s supply of medication. If you receive a transition supply, you will receive a letter from Community Health Choice (HMO D-SNP) notifying you that you have received a temporary supply of your prescription drug. Please refer to your Evidence of Coverage for more detailed information on the transition process.
If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Community Health Choice (“Community”) at no additional cost to you. Learn more about the MTM program by clicking the link below.
Community Health Choice Texas, Inc.’s pharmacy network includes limited lower-cost, preferred pharmacies in our 20 county service area. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-833-276-8306 (TTY: 711) or consult the online pharmacy directory at communityhealthchoice.org/medicare
H9826_IT_10045_092919_M Last updated October 4, 2021. ***Pending CMS Approval***
As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.
“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”– Chandolyn
Member of Community Health Choice