A formulary is a list of covered drugs under a Medicare Advantage Part D Plan. The list includes both brand-name and generic drugs. We have a team of doctors and pharmacists—our Pharmacy and Therapeutics Committee (P&T)—who review our lists of covered medications (formularies) for safety and effectiveness. Based on recommendations from our P&T Committee, we occasionally make changes to the medications covered by our formulary.
Medications on the formulary may change for the following reasons:
- New medications become available and may be added to the formulary.
- Brand-name medications become available as generic. As generic medications become available, the corresponding brand-name medications may be removed from the formulary.
- New pharmacy management programs such as prior authorization, step therapy, or quantity limits are adopted for select medications.
In some cases, if you are already taking a medication when its coverage changes, you will be exempt from those changes for the remainder of the plan year. The exception to this exemption is when a generic medication replaces a brand-name medication in the formulary. When that occurs, we'll notify you, in writing, 30 days before the change takes effect. However, the notice period is waived when a medication is removed for safety reasons.