Drug formulary (covered drugs)

To see our formulary, or list of covered drugs, choose your plan from the list below. Or you can search our formulary online (courtesy of Lexicomp).

 

2024 Kaiser Permanente Marketplace Formulary (PDF)
For those enrolled in a Kaiser Permanente Small Group Plan.

2024 Kaiser Permanente Preventive Rx and OTC drugs (PDF)
List of Preventive prescriptions and over-the-counter drugs covered under the Affordable Care Act (ACA) without cost-sharing when prescribed by a Healthcare Provider.

 

 

2024 Kaiser Permanente Marketplace Formulary (PDF)
For those enrolled in a Kaiser Permanente Large Group Plan.

2024 Kaiser Permanente Preventive Rx and OTC drugs (PDF)
List of Preventive prescriptions and over-the-counter drugs covered under the Affordable Care Act (ACA) without cost-sharing when prescribed by a Healthcare Provider.

 

 

2024 Kaiser Permanente Marketplace Formulary (PDF)
For those enrolled in a Kaiser Permanente Individual and Family Plan.

2024 Kaiser Permanente Marketplace Standard Plans Formulary (PDF)
For those enrolled in a Kaiser Permanente Individual and Family Standard Plan.

2024 Kaiser Permanente Preventive Rx and OTC drugs (PDF)
List of Preventive prescriptions and over-the-counter drugs covered under the Affordable Care Act (ACA) without cost-sharing when prescribed by a Healthcare Provider.

 

 

Medicare Part D formulary
Use this formulary if you have a Kaiser Permanente Medicare health plan.

 

 

QUEST (Medicaid) formulary (PDF)
Use this formulary if you have a QUEST (Medicaid) plan, offered by Kaiser Permanente.

 

 

FEHB Prescription Drug Cost Lookup
Use this formulary if you have an FEHB plan offered by Kaiser Permanente.

 

 

PSHB Prescription Drug Cost Lookup
Use this formulary if you have an PSHB plan offered by Kaiser Permanente.

 

 

The Pharmacy and Therapeutics Committee, a group of Kaiser Permanente doctors and pharmacists, chooses which drugs to include in our formulary. To make sure you always have the most effective, safe, and affordable drug options, the committee regularly reviews information about new and existing drugs. The formulary is updated monthly based on new information or when new drugs become available.

 

 

Drugs that aren’t listed on the formulary, known as nonformulary drugs, aren’t covered by your plan. If your doctor decides that a nonformulary drug is necessary for your care, your doctor can request an exception for that drug. With an exception, the drug will be covered under your prescription drug benefit — if your plan has one. Without an exception, you’ll be charged the full retail price for that drug.

The most effective way to get an exception to the formulary is to send a secure email to your doctor.

You can also contact our Customer Service Center by submitting an online form. Or you can call us Monday through Friday, 8 a.m. to 5 p.m., and Saturday, 8 a.m. to noon, at:

Oahu: 1-808-432-5955
Neighbor islands: 1-800-966-5955
TTY: 1-877-447-5990

Senior Advantage or Medicare Cost members can call our Customer Service Center, 7 days a week, 8 a.m. to 8 p.m., at:

1-800-805-2739
TTY: 1-877-447-5990

If you want a nonformulary drug that your doctor doesn’t believe is medically necessary, you can file a grievance with our Customer Service Center at the phone numbers above.

 

 

For more information about drugs covered by your plan, please contact our Customer Service Center, Monday through Friday, 8 a.m. to 5 p.m., and Saturday, 8 a.m. to noon, at:

Oahu: 1-808-432-5955
Neighbor islands: 1-800-966-5955
TTY: 1-877-447-5990