2017

PLAN
INFORMATION

You have entered the 2017 plan year website. Benefits, formulary, pharmacy network, premium, deductible and/or copayments/coinsurance may change on January 1, 2018. Visit our 2018 website for details.

Medicare Part D Covered Drugs

Express Scripts Medicare covers more than 3,000 brand-name and generic medications in our formulary, including those most commonly prescribed for Medicare members.

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.

When you first join our plan, you’ll receive a copy of the comprehensive formulary. To view our formulary now, click on the plan option you want to review:

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 have prior authorization or step therapy requirements and the rules that apply to each drug:

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 enrolled, 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

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.

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