We may add or remove drugs from our formulary during the year. If we make changes, we must notify members who take the drug that it will be removed at least 30 days before the date that the change becomes effective, or at the time the member requests a refill of the drug.
This includes when we:
- Remove drugs from our formulary
- Add prior authorization
- Quantity limits and/or step therapy restrictions on a drug
- Or, move a drug to a higher cost-sharing tier
If the Food and Drug Administration (FDA) determines that a drug on our formulary is unsafe or the drug's manufacturer removes the drug from the market—we will immediately remove the drug from our formulary and provide notice to members who take the drug.
If your medication is no longer covered by your Medicare Advantage plan, you have two options:
- You can ask Member Services for a list of similar drugs 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 drug that is covered by your plan.
- You can ask your Medicare Advantage plan to make an exception and cover your drug.
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.