The KelseyCare Advantage plans use a Drug Formulary (a list of prescription drugs approved for coverage by KelseyCare Advantage). KelseyCare Advantage will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a KelseyCare Advantage network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
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
Formulary Addendum/ChangesThe Formulary may change at any time. You will receive notice when necessary. To review and/or print formulary changes made during the year, download the
2018 Formulary Addendum. If you would like to request a copy of the formulary addendum to be mailed to your home, please call Member Services at 713-442-CARE (2273) or
1-866-535-8343, 8:00a.m. to 8:00 p.m., 7 days a week. TTY/TDD users should call