Part B & D

To find out more about the medicine coverage in Part D, check out the Summary of Benefits for our plan. It tells you about costs like premiums, copayments, coinsurance, and deductibles. For a full explanation of all the benefits, take a look at the Evidence of Coverage and the 2025 Healthy Mississippi Formulary.

Use this form to ask our plan for a coverage determination from Capital Rx for 2025 or Scripius for 2026.

Prescription drugs are available through our mail-order service,  as well as through our retail network pharmacies. Consider using mail order for your long-term (maintenance) medications (such as high blood pressure medications). Retail network pharmacies may be more appropriate for short-term prescriptions (such as antibiotics).

Step therapy is a type of prior authorization that requires you to try a less expensive drug on the plan’s drug list (formulary) that’s been proven to work for most people with your condition before you can move up a “step” to a more expensive drug.

In case Healthy Mississippi declines your request to cover or pay for a prescription drug, you have the option to request the redetermination (appeal) of their decision.

Federal regulations at 42 CFR § 423.800 specify the requirements of Part D sponsors in the administration of the low-income subsidy program, including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, CMS systems do not reflect a beneficiary’s correct low-income subsidy (LIS) status at a particular point in time.

A coverage decision is when Healthy Mississippi decides what they will help pay for with your medical services or medication. When we make an initial decision about Part D drugs, it's called a "coverage determination."

For more information or to request a Coverage Determination, click  here.

This policy outlines the steps taken by Healthy Mississippi and its pharmacy benefit manager (PBM) to create and manage the Drug Transition Program.

For more information, click here.

Healthy Mississippi offers a complimentary voluntary program for members dealing with multiple medical conditions, taking numerous prescription drugs, and facing high drug costs. If you meet the criteria, you can access this program at no additional cost.

For additional information, click here.

We perform reviews of medication usage for our members to ensure they receive safe and suitable care. These assessments are particularly crucial for members with multiple providers prescribing their medications.

If we identify a potential issue with your medication usage, we will collaborate with your healthcare provider to address and rectify the concern.

More information coming soon.