Formulary Changes

We may make other changes that affect members currently taking a drug. For instance, we may add a generic drug that is not new to market to replace a brand-name drug currently on the formulary; or add new restrictions to the brand-name drug or move it to a different cost-sharing tier or both. Or we may make changes based on new clinical guidelines. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 30 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 30-day supply of the drug. If we make these other changes, you or your prescriber can ask us to make an exception and continue to cover the brand-name drug for you. The notice we provide you will also include information on how to request an exception.

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.