Drug formulary (covered drugs)


Kaiser Permanente offers preventive drugs at lower coinsurance. Please refer to your Evidence of Coverage to find out if qualify.

Preventive drug list (PDF)

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

Medicare Part D formulary

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 Member Services by submitting an online form. Or you can call us, Monday through Friday, 7:30 a.m. to 5:30 p.m., at:

D.C. metro area: 301-468-6000

Other areas: 1-800-777-7902

TTY: 711

If you paid for a nonformulary drug that you want covered by your plan, you can contact Member Services and ask for your prescription claim to be reviewed.

We’ll consider requests, at any time, from Kaiser Permanente members, doctors, or pharmacists to add or remove medications on our formulary. You can download a form (PDF) to submit a request.

For more information, or to receive a copy of our formulary, please contact Member Services, Monday through Friday, 7:30 a.m. to 5:30 p.m., at:

D.C. metro area: 301-468-6000

Other areas: 1-800-777-7902

TTY: 711

You can also send a secure message to Member Services.

 

Reviewed by: Megan Famodu, PharmD, May 2014

NCQA content reviewed by: Susan O’Hardy, NCQA Lead, February 6, 2014

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