Formulary 2017 (List of covered Drugs)
A formulary is a list of covered drugs selected by Senior Care Options program in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Senior Care Options program will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Senior Care Options program network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Commonwealth Care Alliance may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorization, quantity limits, and/or step therapy restrictions on a drug (and/or move a drug to a higher cost-sharing tier), we will notify you of the change at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration (FDA) 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.
List of Covered Drugs
What if my drug is not on the formulary?
If your drug is not included in this formulary, you should first contact Member Services and confirm that your drug is not covered. If you learn that Commonwealth Care Alliance does not cover your drug, you have two options:
- You can ask Member Services for a list of similar drugs that are covered by Commonwealth Care Alliance. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Commonwealth Care Alliance.
- You can ask Commonwealth Care Alliance to make an exception and cover your drug. Click here for information about how to request an exception.
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Last Updated 05/01/2017