Important Member Documents
As a valued member of PPHP in Ohio, you can access your important documents at any time by clicking on the links below.
Member Materials
- 2020 Summary of Benefits
(contains multi-language insert) - 2020 Annual Notice of Change
- 2020 Evidence of Coverage
- 2020 Star Ratings
- 2020 LIS Summary
- Appointment of Representative Form CMS-1696
- Member Reimbursement Form
- Participating Providers
- Participating Pharmacies
- Appeals, Organizational Determinations, Coverage Determinations, Grievances
- Over The Counter (OTC) Catalog
Enrollment
Pharmacy Materials
Formulary 2020
- 2020 Comprehensive Formulary (Prescription Drugs)
(Last Updated 12/1/2020) - 2020 Formulary (Prescription Drugs) Changes
(Last Updated 12/1/2020) - 2020 Prior Authorization Criteria
(Last Updated 12/1/2020) - 2020 Step Therapy Criteria
(Last Updated 12/1/2020) - 2020 Quantity Limits
(Last Updated 12/1/2020) - 2020 Formulary (Prescription Drugs) Search Tool
Additional Pharmacy Information
- Coverage Determination, Appeals, and Grievances Information
- 2020 Request for Medicare Prescription Drug Coverage Determination Form
(Last updated 03/2020) - 2020 Request for Medicare Prescription Drug Coverage Appeal (Redetermination) Form
(Last updated 03/2020) - Online Medicare Prescription Drug Coverage Determination/Appeal (Redetermination)
- 2020 Medicare Prescription Drug Coverage Transition Policy (Last updated 1/2020)
- 2020 Medication Therapy Management Program Description (Last updated 1/2020)