List of Drugs (Formulary)
Our list of drugs (formulary) shows the Part D drugs that we cover. In general, we cover your drugs if they are medically necessary. Drugs on our list of drugs are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.
The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves our list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
How Do I Search for a Drug in the List of Drugs (Formulary)?
You can search for a drug by using the search tool, alphabetical index or by medical condition. There are three ways to find out if your drug is covered.
Search Tool: Open the List of Drugs (PDF). Hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key.
Alphabetical Index: The index at the end of the PDF lists the names of generic and brand name drugs from A to Z. Once you find a drug name, go to the page number listed to see if the drug is covered.
Medical Condition: The drugs are grouped into categories by type of medical condition that they are used to treat. For example, “Cardiovascular Agents – Drugs to Treat Heart and Circulation Conditions. If you know what your drug is used for look through the list to find the category. Then look under the category for your drug.
You can ask us to make an exception to our rules for your drug(s). To learn how, read your Evidence of Coverage or visit our Plan Materials and Forms page. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.
Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You can ask for a fast (expedited) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s statement.
List of Drugs Change Notice
Drugs may be added or removed from our list of drugs during the year. We will tell you 60 days before the following changes are made to the list of drugs:
- Remove a drug from the list.
- Change drug requirements.
- Move a drug to a higher cost sharing tier.
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away.
See 2020 information for more details.