Drug formulary (covered drugs)

Use the California Marketplace Formulary if you are enrolled in a non-grandfathered individual & family or small group plan.

California Marketplace Formulary (PDF)

California Marketplace Formulary (Spanish) (PDF)

California Marketplace Formulary (Chinese) (PDF)

The following plans are non-grandfathered individual & family or small group plans:

• Individual & family Platinum, Gold, Silver, Bronze, Minimum Coverage, and $0 Cost Share plans purchased through Covered California (also known as the Exchange)
• Individual & family Platinum, Gold, Silver, and Bronze, and Minimum Coverage plans purchased directly through Kaiser Permanente
• Small group Platinum, Gold, Silver, and Bronze plans purchased by a small group employer through Covered California (also known as the Exchange) or directly through Kaiser Permanente
• All small group plans purchased by a small group employer through California Choice

Use the California Commercial HMO Formulary if you are enrolled in a grandfathered individual & family or small group plan:

California Commercial HMO Formulary (PDF)

California Commercial HMO Formulary (Spanish) (PDF)

California Commercial HMO Formulary (Chinese) (PDF)

Grandfathered coverage is defined as follows:

• Grandfathered small group plans (a small group plan established by your employer prior to March 23, 2010)
• Grandfathered individual & family plans (an individual & family plan purchased prior to March 23, 2010)

For more information on your plan’s formulary, see the "About the drug formulary" section in your Evidence of Coverage. If you have questions please contact Member Services.

Use this formulary if you are enrolled in large group coverage.

California Commercial HMO Formulary (PDF)

California Commercial HMO Formulary (Spanish) (PDF)

California Commercial HMO Formulary (Chinese) (PDF)

For more information on your plan’s formulary, see the "About the drug formulary" section in your Evidence of Coverage. If you have questions please contact Member Services.

Use this formulary if you are a Kaiser Permanente Bernard J. Tyson School of Medicine student or dependent.

School of Medicine Formulary (PDF)

Outpatient Prescription Drug Coverage (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

Use these formularies if you have a KPIC point-of-service (POS), preferred provider organization (PPO), or out-of-area (OOA) indemnity plan.

POS standard formulary — MedImpact pharmacy (PDF)

POS formulary with specialty drug tier — MedImpact pharmacy (PDF)

PPO/OOA standard formulary — MedImpact pharmacy (PDF)

PPO/OOA formulary with specialty drug tier — MedImpact pharmacy (PDF)

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 consultation 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:

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