A formulary is a list of drugs covered by our plan to meet our members’ prescription drug needs.

Click on the first letter of the drug name to get a listing of all drugs that start with that letter.

Search our 2009 Drug Formulary A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  This Drug Formulary was updated on 11/4/08

Search results will provide you detailed information about the drug, including:

• The drug name and dose
  Lowercase letters = generic drugs
  Capitalized letters = brand name drugs
• The drug copay/coinsurance at Preferred and Non-Preferred pharmacies
• Notes lists letters or symbols that indicate requirements, limits, coverage for drugs not usually covered by Medicare and drugs that are not distributed through most retail pharmacies.
• PA = Prior Authorization is needed from KelseyCare Advantage before receiving this drug. CLICK here to view the PA criteria
• ST = Drug is part of a step therapy program that requires the use of one or more "first step" drugs to treat a condition before the use of a "second step" drug will be approved
• QL = Denotes that there is a quantity limit for this drug
• * = Drug is not usually covered by Medicare but is covered by KelseyCare Advantage Rx
• ** = Drug can only be purchased at a specific network pharmacy

Appeals and Grievances
For more information about our appeals and grievances policies and procedures which include exceptions processes. Click here

KelseyCare Advantage Covers Brand and Generic Drugs
KelseyCare Advantage covers both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Quick Answers
Click here for quick answers to frequently asked questions about the drug formulary.