Quick Reference Guide - chooseultimate.com
You should request a Coverage Determination to ask us for: • Coverage of a Part D drug that is not listed on the Formulary (NFE) • Drugs listed on the Formulary with a Prior Authorization (PA)
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Over-the-Counter (OTC) Benefit
www.chooseultimate.comUsing Your OTC Benefit: Using your over-the-counter benefit is easy as 1-2-3. Use your monthly benefit allowance to purchase health- and wellness-related items. Your order is conveniently shipped directly to your home. HOW TO PLACE AN ORDER: 1. Select your products Choose from the list of available medications and products found on the following
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