Medicare Advantage Pharmacy Benefits

We have a team of physicians and pharmacists—our Pharmacy and Therapeutics Committee (P&T)—who review our lists of covered medications (formularies) for safety and effectiveness. Based on recommendations from our P&T Committee, we occasionally make changes to the medications covered by our Formulary.

Medications on the formulary may change for the following reasons:

  • New medications become available and may be added to the formulary.

  • Brand-name medications become available as generic. As generic medications become available, the corresponding brand-name medications may be removed from the formulary.

  • New pharmacy management programs such as prior authorization, step therapy, or quantity limits are adopted for select medications.

In some cases, if you are already taking a medication when its coverage changes, you will be exempt from those changes for the remainder of the plan year. The exception to this exemption is when a generic medication replaces a brand-name medication in the formulary. When that occurs, we will notify you, in writing, 60 days before the change takes effect. However, the notice period is waived when a medication is removed for safety reasons.

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