2018

PLAN
INFORMATION

Express Scripts Medicare Part D Formulary Drugs

Express Scripts Medicare offers reliable coverage for the most commonly prescribed brand and generic medications.

See if your drugs are covered and find out which plan is right for you based on where you live, the drugs you take and the pharmacy you use.

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Medicare Part D Formulary (drug list)

A formulary is the list of drugs covered by a Part D plan. Medicare requires all Part D plans to cover at least two drugs in each therapeutic drug category. Some types of drugs are not covered by Medicare Part D, such as drugs for weight loss or cosmetic purposes.

To view and/or print our formulary now, click on the plan option below:

You may also access our online searchable tool to confirm if your drugs are covered and to see if there are any special coverage rules.*

Prior authorizations and changes to the formulary

Some drugs may have special coverage rules associated with them. These rules may limit the amount of a particular drug you can get, require that you obtain prior approval from the plan before the drug will be covered, or that you first try a certain drug to treat your medical condition before another drug will be covered. Drugs that are subject to these rules are clearly marked in the formulary guide.

View the list of prescription drugs that currently have prior authorization or step therapy requirements and the rules that apply to each drug:

Saver plan
Value plan
Choice plan

Express Scripts Medicare plans will generally cover the drugs listed in the formulary as long as:
  • The drug is medically necessary
  • The prescription is filled at a network pharmacy
  • Other plan rules are followed

For more information on how to fill your prescriptions, please review the Evidence of Coverage.

Once coverage begins, you may request an exception to our coverage rules. Read more about our exceptions and appeals process now.

In addition, we may periodically:
  • Add or remove a drug
  • Make changes to coverage rules on certain drugs
  • Change how much you pay for a drug

If we make any formulary change that limits your ability to fill prescriptions, we will notify you at least 60 days before the change is made.

Note: If the U.S. Food and Drug Administration finds that a drug on the formulary is unsafe, or if the drug's manufacturer removes the drug from the market per Medicare Part D regulations, we immediately remove the drug from our formulary and then notify you of the change.

Need help?

Call 1.866.477.5703 TTY users: 1.800.716.3231
8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas

*If you want a comprehensive formulary mailed to you or if you have questions about covered drugs, please call 1.866.477.5703, 8 a.m. to 8 p.m., 7 days a week, except Thanksgiving and Christmas. TTY users, call 1.800.716.3231. You may also email your request for a formulary to formulary@express-scripts.com. Requests sent by email must include: Full name, telephone number and mailing address.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary may change at any time. You will receive notice when necessary.

Express Scripts Medicare (PDP) is a prescription drug plan with a Medicare contract.
Enrollment in Express Scripts Medicare depends on contract renewal.