Medicare Advantage Pharmacy Benefits

We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, 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 members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug.

If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

The following links provide information about updates that have been made to our plans' formularies.

PDF Notice to Formulary Changes for HMO plans

PDF Notice to Formulary Changes for PPO plans

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 drugs 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 drug that is covered by your plan.

  • You can ask your Medicare Advantage plan to make an exception and cover your drug. Contact Member Service at
    1-800-200-4255 (TTY: 1-800-522-1254), 8:00 a.m. to 8:00 p.m. ET as follows: from February 15 through September 30, Monday through Friday, and from October 1 through February 14, seven days a week, for information about how to request an updated coverage determination or an exception to a coverage determination.