Community Care Home   Community Care on Facebook  Community Care on LinkedIn   

Contact Us At:



The formulary is the list of drugs covered by Community Care. It is also called the "Drug List". The drugs on this list were selected with the help of doctors and pharmacists. The list must meet the requirements of Medicare and/or Medicaid.

The formulary explains what prescription drugs are covered by the plan. It also tells you if there are any rules that limit coverage of a drug. PACE provides prescription drugs and certain over-the-counter medications for all members.

If you have Medicare, your prescription drug coverage is through Medicare Part D. If you have Medicaid only, your prescription drug coverage is through Wisconsin Medicaid. All PACE members have the same prescription drug coverage and benefits.


Coverage Limits
Some covered drugs have limits or conditions for coverage.  The following documents explain the limits and conditions:

  • Formulary Prior Authorization Criteria -  Click Here
    PACE must approve these drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
  • Formulary Step Therapy CriteriaClick Here
    We require you to first try certain drugs to treat your medical condition before we will cover another drug for your condition.

Part D Formulary Transition Policy


Material ID: H5212_Form_11.2015 CMS Approved: 12/8/2015

Home   |   Who We Are   |   Members & Families   |   For Providers   |   Careers   |   Consulting Services   |   Contact Us

 Corporate Headquarters: 205 Bishops Way, Brookfield, WI 53005
Phone: (414) 231-4000 Toll Free: 1-866-992-6600 TTY: Call the Wisconsin Relay System at 711
Help in Other Languages
© 2014-2019, Community Care, Inc. - All Rights Reserved   |   Privacy Policy   |   Terms of Use