We may add or remove medications from our formulary during the year. If we make changes, we must notify members who are taking the medications at least 30 days before the change becomes effective, or at the time a member requests a refill of the medication.
This process happens when we:
- Remove medications from our formulary
- Add prior authorization requirements to a medication
- Add quantity limits or step therapy restrictions on a drug
- Move a medication to a higher cost-sharing tier
If the Food and Drug Administration (FDA) determines that a medication on our formulary is unsafe or the medication's manufacturer removes the medication from the market, we'll immediately remove the medication from our formulary and provide notice to members who take the medication.
If your medication is no longer covered by your Medicare Advantage plan, you have two options:
- You can ask Member Service for a list of similar medications that are covered by your Medicare Advantage plan. When you receive the list, show it to your doctor and ask him or her to prescribe a similar medication that is covered by your plan.
- You can ask your Medicare Advantage plan to make an exception and cover your medication.
Contact Member Service at 1-800-200-4255 (TTY: 711), 8:00 a.m. to 8:00 p.m. ET as follows: from April 1 through September 30, Monday through Friday, and from October 1 through March 31, seven days a week, for information about how to request an updated coverage determination or an exception to a coverage determination.