Drug Search - See if your drug is covered
Can the Formulary (drug list) change?Generally, if you are taking a drug on our 2019 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2019 coverage year except when a new, less expensive generic drug becomes available, when new information about the safety or effectiveness of a drug is released, or the drug is removed from the market. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. Below are changes to the drug list that will also affect members currently taking a drug:
Are there any restrictions on my coverage?Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:
What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services and ask if your drug is covered. If you learn that KelseyCare Advantage does not cover your drug, you have two options:
How do I request an exception to the KelseyCare Advantage’s Formulary?You can ask KelseyCare Advantage to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.
Part D Temporary Transition SupplyUnder certain circumstances, the plan can offer a temporary supply when your drug is not on the Drug List or when it is restricted in some way. These
guidelines define the eligibility criteria for a temporary transition supply.
*A long-term supply is not available for drugs in Tier 5