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 formulary 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.
- We adopt new pharmacy management programs such as prior authorization, step therapy, or quantity limits for select medications.
In some cases, if you're already taking a medication when its coverage changes, you'll be exempt from those changes for the rest of the plan year. However, when a generic medication replaces a brand-name medication in the formulary, we'll notify you in writing 30 days before the change takes effect. If a medication is removed for safety reasons, the change is immediate and we'll notify you in writing.
- 2021 Medicare HMO/PPO Blue 6-Tier Formulary (Updated 07/01/2021)
- 2021 Medicare HMO/PPO Blue 5-Tier Formulary (Updated 07/01/2021)
- 2021 Medicare HMO/PPO Blue Non-Formulary Quantity Limits (Updated 05/01/2021)
- Appeals & Grievances procedure