Coverage and Benefits

Plan Documents

Drug List (Formulary)

• Drugs on this list are organized into different cost groups, or tiers. The cost of your medication depends on which tier the drug is in.

• Some drugs may require prior authorization, have quantity limits or have a step therapy requirement.

• Medicare covers some drugs and supplies under Part A or Part B instead of your Part D plan. This includes items such as diabetic testing supplies, home infusion drugs and allergy injections.

Prior Authorization Criteria