Drug formulary (covered drugs)


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

Medicare Part D formulary

Use this formulary if you have a QUEST Integration, or Medicaid plan, offered by Kaiser Permanente.

QUEST Integration formulary (PDF)

Use this formulary if you have an FEHB plan offered by Kaiser Permanente.

FEHB Prescription Drug Cost Lookup

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

 

*Guidelines and/or restrictions may apply for the medications on this list to be covered at $0 coinsurance.

Reviewed by: Corinne Domingo, May 2014

NCQA content reviewed by: Susan T. Wilson, NCQA Lead, January 24, 2014

This page was last updated: October 8, 2018, at 12 a.m. PT