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).


Use this formulary if you bought your Kaiser Permanente coverage through Covered California, the state’s health insurance marketplace.

California marketplace formulary (PDF)

California marketplace formulary (Spanish) (PDF)

California marketplace formulary (Chinese) (PDF)

Use this formulary if you have Kaiser Permanente coverage through Medi-Cal.

Medi-Cal formulary (PDF)

Medi-Cal formulary (Spanish) (PDF)

Medi-Cal formulary (Chinese) (PDF)

Use this formulary if you have Kaiser Permanente Exclusive Provider Organization (EPO) or Deductible EPO (DEPO) Self-Funded Plan.

Self-Funded formulary (PDF)

Self-Funded formulary (Spanish) (PDF)

Self-Funded formulary (Chinese) (PDF)

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

Medicare Part D formulary

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

FEHB formulary (PDF)

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.

When a generic version of a brand-name drug on our formulary becomes available and meets our standards, it usually replaces the brand-name drug on our formulary.

When compared to the brand-name version, generic drugs usually:

  • Contain the same active ingredients
  • Are similar in dosage, strength, safety, and quality
  • Have similar benefits, side effects, and risks
  • Are more cost-effective

Sometimes generic drugs are made by the same drug company that makes the brand-name version.

When a generic drug is added to our formulary, in most cases your pharmacist will automatically change your brand-name prescription to the generic version at your next refill.

Sometimes a prescription is changed from one medication to another because we’ve decided the new drug is a better option based on standards of safety, effectiveness, or affordability. This is known as “therapeutic interchange.”

Usually, when a medication change like this happens, your pharmacist will automatically change your prescription to the new medication at your next refill.

If a drug you’re taking is affected by a change to the formulary, you may be able to continue receiving it if your doctor decides it’s medically necessary.

Please note that just because a drug is on our formulary, it doesn’t mean your doctor will prescribe it for you. Your doctor will choose the right drug for you based on your medical needs.

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

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 the drug.

Talk to your doctor if you would like an exception to the formulary.

You can also call Member Services, 24 hours a day, 7 days a week (closed holidays), at:

English: 1-800-464-4000
Spanish: 1-800-788-0616
Chinese dialects: 1-800-757-7585
TTY: 711

If you want a nonformulary drug that your doctor doesn’t believe is medically necessary, you can file a grievance (Senior Advantage and Medicare Cost members can file an appeal) with Member Services by calling one of the numbers above.

For more information about our drug formulary, please contact Member Services, 24 hours a day, 7 days a week (closed holidays), at:

English: 1-800-464-4000
Spanish: 1-800-788-0616
Chinese dialects: 1-800-757-7585
TTY: 711

 

NCQA content reviewed by: Sheila Hill, NCQA Lead, February 5, 2014

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