Forms & Resources

Enrollment Materials

The Summary of Benefits provides a summary of what the plan covers and what you pay.

You may also use this form to join Mutual of Omaha Rx. Print our online enrollment form and then complete and mail it to:

Mutual of Omaha Rx (PDP)
P.O. Box 3625
Scranton, PA 18505

Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Part D plans based on a 5-star rating system. CMS considers how well the plans perform in different categories, including customer service, patient safety, and member experience and satisfaction.

Currently, Mutual of Omaha is being evaluated and does not have a star rating. The official CMS Star Rating can be found at

The Multi-Language Insert is a document that contains information about free language interpreter services available to you.


The formulary is a list of prescription drugs that is approved for coverage under Mutual of Omaha Rx. Be sure to select the one that applies to your plan option and learn more about our formulary.

Please note: The formulary for each plan option may change at any time. You will receive notice when necessary.

Prior Authorization

We require you to get prior authorization for certain drugs. This means that your doctor will need to get approval from us before you fill your prescription. If they don’t get approval, we may not cover the drug. Use these documents to view the lists of drugs that have prior authorization and the rules that apply to each drug.

Step Therapy

In some cases, we require you to try certain drugs first to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B. Use these documents to view the lists of drugs that have step therapy requirements and the rules that apply to each drug.

Annual Notice of Change

The Annual Notice of Change includes any changes in coverage, costs, or service area that will be effective starting in January.

Need Help?

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Have questions about our PDP plans? Call one of our agents today.

If you have any questions, please contact Mutual of Omaha Rx at 855-864-6797. Customer Service is available 24 hours a day, 7 days a week. TTY users should call 800-716-3231.


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