Healthy Mississippi gives you a special Medicare Advantage plan. This plan includes Medicare Part D, which helps you pay for medicine you get from the pharmacy. It also helps with vaccines and some things not covered by other parts of Medicare, like Part A or Part B.

Part D Prescription Drug Benefits

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.

CapitalRx Member Portal Login

For more information about coverage, co-pays, or payment options, please log into your prescription drug portal.

To log into your prescription drug portal, click here.

CapitalRx Coverage Determination Requests

Use this form to ask our plan for a coverage determination or redetermination from CapitalRx.

Pharmacy Authorization (Part B)

Pharmacy Authorization Part B refers to the process of obtaining approval for certain medications under Medicare Part B, which covers outpatient drugs that are not typically covered by Part D.

Mail-Order Pharmacy

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).

Prior Authorization Criteria

This document shows the criteria needed for Healthy Mississippi coverage on prescription drugs and other forms of medical care.

Best Available Evidence (BAE)

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.

Coverage Determination

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.

Drug Transition Policy

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.

Coverage Redetermination (Appeal)

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.

Medication Therapy Management Program (MTMP)

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.

Quality Assurance Policy

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.

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