2019

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 pharmacies you use.

Find a Plan

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.

Express Scripts Medicare plans typically cover the drugs listed in the formulary, as long as:

  • The drug is medically necessary
  • The prescription is filled at one of 67,000 pharmacies in our network
  • Any special drug coverage rules are followed, as required

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.*

Special drug coverage rules

Some drugs have special coverage rules that may:

  • Limit the amount of a particular drug you can get
  • Require that you get prior approval from the plan before a drug is covered (known as prior authorization)
  • Require that you try a certain drug to treat your condition before another drug is covered (known as step therapy)
  • Limit which pharmacies you can use

Drugs that are subject to these rules are clearly marked in the formulary.

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

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. Learn more about exceptions and appeals.

Formulary changes

Express Scripts Medicare plans may periodically:

  • Add or remove a drug from the Drug List
  • Move a drug to a higher or lower cost-sharing tier
  • Add or remove a restriction on coverage for a drug
  • Immediately replace a brand-name drug with a generic drug

If we make certain changes to our formulary for a drug you are taking, we will notify you at least 30 days before the change is made or give you a 30-day refill of the drug at a network pharmacy.

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 under Medicare Part D regulations, we immediately remove the drug from our formulary and then notify you of the change.

For additional information on formulary changes, please review Chapter 3 of the Evidence of Coverage.

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 documents@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. Call 1.866.477.5703 (TTY: 1.800.716.3231) for more information.

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