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). Last Update: May, 2020
Use these formularies if you have a KPIC point-of-service (POS), preferred provider organization (PPO), or out-of-area (OOA) indemnity plan.
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.
Exceptions to the formulary may be obtained through consulation with your doctor. You and your doctor are best able to determine your medication needs. You may send an email to your doctor via this link.
You can also call Member Services, 24 hours a day, 7 days a week (closed holidays), at:
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.
NCQA content reviewed by: Sheila Hill, NCQA Lead, February 5, 2014
This page was last updated: October 8, 2018, at 12 a.m. PT