How our formulary works

The Pharmacy and Therapeutics Committee, a group of Kaiser Permanente doctors and pharmacists, chooses which drugs to include on our list of covered drugs, known as a formulary. The committee meets regularly to review and choose the safest, most effective medications for our members.

What drugs are covered?

Drugs on the formulary are covered by your plan’s prescription drug benefit — if your plan has one. Please note that not all plans are the same. For example, some plans may not include certain drugs, cover generic drugs only, or limit the amount of a drug you can get with each prescription or copay.

If your plan doesn’t include a prescription drug benefit, you can still use a Kaiser Permanente pharmacy, but you’ll need to pay the full retail price for your prescriptions.

What drugs are not covered?

Drugs that aren’t listed on the formulary, known as nonformulary drugs, aren’t covered by your plan. Prescriptions for nonformulary drugs may be filled at Kaiser Permanente pharmacies. But you should expect to pay the full retail cost — unless your doctor receives an exception for that drug.

Drugs that aren’t usually covered by your Kaiser Permanente prescription drug benefit include:

  • Drugs prescribed for cosmetic purposes
  • Drugs related to a service not covered by your plan
  • Drugs used to enhance athletic performance
  • Drugs used to lose weight
  • Drugs used to treat symptoms of the common cold
  • Experimental drugs
  • Vitamins and nutritional supplements

Please refer to your Evidence of Coverage for more information about your prescription drug coverage.

Find out what drugs are covered in your area.

 


Reviewed by: Mark Groshek, MD, and David McWaters, PharmD, JD, May 2014
© 2014 Kaiser Permanente