Medicare Drug List Formulary

HealthSpring Medicare Part D Drug Lists

Each Medicare Part D Prescription Drug Plan must follow the rules set forth by Medicare for covering Part D drugs and be approved by Medicare each year. Medicare Part D Prescription Drug Plans must include at least two drugs in every drug category. In addition, each Medicare Part D Prescription Drug Plan must:

• Make sure you have convenient access to retail pharmacies

• Have a process to request exceptions to the drug list

• Provide useful information to you, such as how drug lists and medication management programs work, information on saving money with generic drugs and grievance and appeal processes

Not all prescription drugs are included on the drug list. In some cases, the law prohibits Medicare coverage of certain types of drugs. In other cases, we have decided not to include a particular drug on our drug list because we may have an alternative drug that can be taken.

Generics

All Medicare Part D Prescription Drug Plans cover various brand-name drugs and generic drugs. Generic drugs have the same active ingredients as brand-name drugs. 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.

Medicare Drug Formulary Changes

During a plan year, HealthSpring may make certain changes to our list of covered drugs. Most changes throughout the year will have a positive impact on customers such as adding new drugs to our drug list, removing restrictions, or moving a medication to a lower cost-sharing tier.

Plans are limited in their ability to make changes during the year that will have a negative impact on customers. A negative change would be removing a medication, moving it to a higher cost-sharing tier, or adding a new requirement. If you are taking the medication with the change, you will generally be notified on your Explanation of Benefits (EOB) statement. We also may make a change when a new generic becomes available.

It is important that you check your plan’s drug list PDF on this page or the 2026 Medicare Prescription Pricing and Comparison Tool to confirm the coverage of your medications.

Transitioning to a New Plan

We can help if you need to switch to a different drug that we cover or request a formulary exception.

2026 Prescription Drug Transition Policy [PDF]

Formulary Frequently Asked Questions

Medicare Advantage with Prescription Drug Coverage Plan Formulary FAQs [PDF]

Standalone Medicare Part D Prescription Drug Plan Formulary FAQs [PDF]