Covered Drugs with Gold Kidney Medicare Advantage Plans

Covered Drugs, Formulary & Forms

To access our medication pricing tool, please click here.

For more in-depth information, see our pharmacy and formulary documents below

Formulary Drug List AZ - English

For the following plans:
Gold Heart & Diabetes
Gold Dialysis

For the following plans:
Gold Advantage

For the following plans:
Gold Heart & Diabetes Complete
Gold Dialysis Complete
Gold Circle Heart & Diabetes
Gold Circle Dialysis

Download English

Formulary Drug List AZ - Spanish

For the following plans:
Gold Heart & Diabetes
Gold Dialysis

Download Spanish

For the following plans:
Gold Advantage

Download Spanish

For the following plans:
Gold Heart & Diabetes Complete
Gold Dialysis Complete
Gold Circle Heart & Diabetes
Gold Circle Dialysis

Download Spanish

Formulary Drug List FL - English

For the following plans:
Gold Heart & Diabetes
Gold Dialysis / Diálisis de Oro
Gold Health / Salud de Oro

Download English

For the following plans:
Gold Advantage

Download English

For the following plans:
Gold Heart & Diabetes Complete / Salud de Oro Completa
Gold Dialysis Complete / Diálisis de Oro Completa

Download English

Formulary Drug List FL - Spanish

For the following plans:
Gold Heart & Diabetes
Gold Dialysis / Diálisis de Oro
Gold Health / Salud de Oro

Download Spanish

For the following plans:
Gold Advantage

Download Spanish

For the following plans:
Gold Heart & Diabetes Complete / Salud de Oro Completa
Gold Dialysis Complete / Diálisis de Oro Completa

Download Spanish

Formulary Change Notice

Prior Authorization Drug List

Step Therapy Drug List

Medicare Prescription Payment Program (MPPP)

MedImpact Direct Mail® Program

Drug Utilization Review Policy

Model Part D Coverage Determination and Redetermination Form

Birdi Prescription Mail Order

Understanding the Transition Process

Submit Prior Authorization Request (Prescription Coverage Determination Request Form)

Prescription Drug Claim Form

Blank Personal Medication List (PML)

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Covered Drugs, Formulary & Forms

To access our medication pricing tool, please click here.​

For more in-depth information, see our pharmacy and formulary documents below

For all inquiries, please call Member Services at (844) 294-6535

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To access our medication pricing tool, please click here.