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2013 Pharmacy & Part D Coverage Information
Freedom Health uses a network of pharmacies that is equal to or exceeds CMS requirements for pharmacy access in your area. In the State of Florida, Freedom Health has 4,497 pharmacies in their network. These pharmacies are contracted through our Pharmacy Benefit Administrator, Spectral Solutions.
To search for a pharmacy, click on the "Pharmacy Network Listing" link below. Select your "County" and "Provider Type" then click on the “Search Now” button.
A formulary is a list of drugs covered by your plan to meet patient needs.
To search for a drug, click on the link below. Once the page is opened, select your county and plan then type in your drug name or drug category in the “Search” box. You can even download the Formulary in a PDF version.
For information on obtaining an updated coverage determination or an exception to a coverage determination please call Member Services at 1-800-401-2740. Hours of operation from October 1, 2012 to Feb. 14 , 2013 , are 7 days a week from 8:00 AM to 8:00 PM. ( EST ) From Feb. 15, 2013 to September 30, 2013, hours of operation are Monday through Friday from 8:00 AM to 8:00 PM. ( EST ) TTY/TDD users should call 1-800-955-8771.
Formulary list may change during the year. Updates, if any, will be posted monthly.
- What is a formulary?
- Can the formulary change?
- What about generic drugs?
- What if my drug isn't in the formulary?
- Click here to learn which drugs require Prior Authorization.
- Click here to find the Provider Exception Request form.
What can you do if your drug is not on the Drug List?
(You will be redirected to this site)
Members and providers who have questions about the Grievance and Appeals processes, need the status of a coverage determination or want to receive an aggregate number of grievance, appeals, and exceptions filed with the plan sponsor please contact Member Services.
- Coverage Determinations & Appeals, Grievances & Exceptions
- Request For Medicare Prescrition Drug Coverage Determination
The Appointment of Representative Form (PDF, 66 KB) is located on the CMS Web site.
Beneficiaries and providers may appoint another individual, including an attorney, as their representative in dealings with Medicare, including appeals you file. Form CMS-1696, Appointment of Representative form, must be submitted with the appeal and is valid for one year from the date. The form must be signed by both you and the appointed representative. A representative may be designated at any point in the appeals process. This representative may assist you during the processing of a claim or claims and/or any subsequent appeal. Refer to the CMS Medicare Claims Processing Manual (PDF, 605 KB) (Pub. 100-04, chapter 29, section 270.1.10) for information on disclosing information to third parties.
The following types of individuals may be appointed to act as representative for a party to an appeal. This list is not exhaustive and is meant for illustrative purposes only:
- Congressional staff members
- Family members of a beneficiary
- Friends or neighbors of a beneficiary
- Members of beneficiary advocacy groups
- Members of provider or supplier advocacy groups
- Physicians or suppliers
The party making the appointment and the individual accepting the appointment must either complete an appointment of representative form (CMS-1696) or use a conforming written instrument. Refer to the CMS Medicare Claims Processing Manual (Pub. 100-04, chapter 29, section 270.1) for required elements of written instruments. You may appoint a representative at any time during the course of an appeal. The representative must sign the CMS-1696 or other conforming written instrument within 30 calendar days of the date the beneficiary or you sign an order for the appointment to be valid. By signing the appointment, the representative indicates his/her acceptance of being appointed as representative.
The CMS-1696 is available for the convenience of the beneficiary or you to use when appointing a representative. Instructions for completing the form:
- The name of the party making the appointment must be clearly legible. For beneficiaries, the Medicare Health Insurance Claim (HIC) number must be provided.
- Completing Section I - 'Appointment of Representative' - A specific individual must be named to act as representative in the first line of this section. A party may not appoint an organization or group to act as representative. The signature, address and phone number of the party making the appointment must be completed and the date it was signed must be entered. Only the beneficiary or the beneficiary’s legal guardian may sign when a beneficiary is making the appointment. If the party making the appointment is the provider or supplier, someone working for or acting as an agent of the provider or supplier must sign and complete this section.
- Completing Section II - 'Acceptance of Appointment' - The name of the individual appointed as representative must always be completed and his/her relationship to the party entered. The individual being appointed must then sign and complete the rest of this section.
- Completing Section III - 'Waiver of Fee for Representation' - This section must be completed when the beneficiary is appointing a provider or supplier as representative and the provider or supplier actually furnished the items or services that are the subject of the appeal.
- Completing Section IV - 'Waiver of Payment for Items or Services at Issue' - This section must be completed when the beneficiary is appointing a provider or supplier who actually furnished the items or services that are the subject of the appeal and involve issues describe in section 1879(a)(2) of the Social Security Act.
If any one of the elements listed above is missing from the appointment, the adjudicator shall contact the party (individual attempting to act as a beneficiary’s representative) and provide a description of the missing documentation or information. Unless the missing information is provided, the prospective appointed representative lacks the authority to act on behalf of the party and is not entitled to obtain or receive any information related to the appeal, including the appeal decision. The adjudicator will not dismiss the appeal request because the appointment of representative is not valid.
Mail or fax this statement to the Plan at:
Grievance and Appeals Department
PO Box 152727
Tampa, FL 33684 Fax: 1-813-506-6235
You can also call the Member Services Department to learn more about how to name your appointed representative.
To learn more about how to ask for an Exception, a Coverage Determination, Appeal or to make a complaint, click on a link below:
- Coverage Determinations & Appeals, Grievances & Exceptions
- Coverage Determination Request Form
- Redetermination Request Form