Enrollment Update: Prescription Advantage will stop accepting new applications after September 11, 2026. If you are currently enrolled, your participation in the program will continue.
Member Forms
Prescription Drug Reimbursement Form — Non-Medicare Members
Use this form to request reimbursement for prescription drug costs paid out of pocket. Download Prescription Drug Reimbursement Form — Non-Medicare Members
Self-Attestation of Income Change — Existing Member
Use this form to report income changes that may affect eligibility or membership category. Download Self-Attestation of Income Change — Existing Member
Representative Authorization Form
Use this form to authorize someone to act on your behalf or receive information about your benefits. Download Representative Authorization Form
Rate Schedules
Members Eligible for Medicare or Other Drug Coverage
Income eligibility and benefit information for members with Medicare or other drug coverage.
Download English rate schedule
Download Spanish rate schedule
Members Not Eligible for Medicare or Other Drug Coverage
Income eligibility, copayments, deductibles, and reimbursement information.
Download English rate schedule
Download Spanish rate schedule
Helpful Resources
Find contact information for SHINE, Medicare, MCPHS Pharmacy Outreach, and MassHealth Customer Service.
Download helpful resources