Drug formulary (covered drugs)


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. For nonformulary drugs, you have the following options:

  • You can pay full retail price for the prescription.
  • You can ask your doctor to prescribe a similar drug that’s included on our formulary.
  • You can ask your doctor to request an exception so your nonformulary drug can be covered by your prescription drug benefit.**

The most effective way to get an exception to the formulary is to send a secure email to your doctor.

You can also call Member Services at 1-888-681-7878 (TTY 711), Monday through Friday, from 8 a.m. to 6 p.m. Or you can submit an online form.

View a list of pharmacies that fill prescriptions for certain specialty drugs.

Colorado HMO specialty pharmacy info (PDF)

For more information, or to receive a copy of our drug formulary, please contact Member Services at 1-888-681-7878 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m.

You can also send a secure message to Member Services.

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

 

*EPO is a self-funded plan.

**Does not apply to EPO members

Reviewed by: Xiaolan Liang, PharmD, BCPS, May 2014

NCQA content reviewed by: Ellen Gibson, NCQA Lead, February 6, 2014

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