Drug formulary (covered drugs)

To see our formulary, or list of covered drugs, choose your plan from the list below.

 

HMO formulary (PDF) - or search this formulary online (courtesy of Lexicomp)

 

 

Small Employer Group / Large Employer Group

Flexible Choice and out-of-area, preferred provider organization (OOA-PPO) formulary (PDF)

 

 

Commonwealth of Virginia Medicaid and FAMIS Preferred Drug List
Commonwealth of Virginia Medicaid and FAMIS preferred drug list (PDF)

Maryland HealthChoice Drug List
Maryland HealthChoice preferred drug list (PDF)

 

 

Learn more about what Kaiser Permanente considers specialty drugs. For more information about whether this list applies to your plan, please refer to your Evidence of Coverage.

Specialty drugs list (PDF)

 

 

You or your doctor can request coverage for prior authorization drugs or nonformulary drugs. Requests are reviewed based on our coverage criteria or medical necessity. If we approve a request, you pay a cost share determined by your member contract. If we do not approve the request, you can get the medication and pay full price.

Prior Authorization Forms

 

 

A new policy allows coverage of a maximum of a 90-day supply of many maintenance drugs, effective 10/1/2021. The list (PDF) of eligible maintenance drugs has been developed to include many chronic medications on the Commonwealth of Virginia Medicaid and FAMIS Preferred drug list. Members will be eligible for this policy after receiving two 34-day or shorter fills of drugs on this list. This new maintenance list is not all-inclusive. If your medication is not on the maintenance list, you may receive a maximum 34-day supply of your prescriptions.

 

 

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: 1-301-468-6000
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: 1-301-468-6000
Other areas: 1-800-777-7902
TTY: 711

You can also send a secure message to Member Services.