Search our online drug formulary (courtesy of Lexi-Comp). You'll find each medication's brand name, generic name (if available), and dosage form.
2016 California Marketplace Formulary
PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER WHEN YOU PARTICIPATE IN A QUALIFIED HEALTH PLAN OFFERED BY KAISER PERMANENTE, AND INCLUDES THE HEALTH INSURANCE MARKETPLACE (IN CALIFORNIA, MARKETPLACE IS KNOWN AS COVERED CALIFORNIA).
This formulary is effective as of 9/1/2016.
Medi-Cal Over-the-Counter (OTC) List
Please use the online Lexi-Comp search tool above and this Medi-Cal OTC List (PDF) to find your drug.
Medicare Part D formulary
Learn more about our drug formulary for Senior Advantage members:
Federal Employees Health Benefit formulary
Learn more about our drug formulary when you participate in a Federal Employees Health Benefit (FEHB) plan offered by Kaiser Permanente.
Changes to the formulary
Our Pharmacy and Therapeutics Committee thoroughly reviews medical literature and selects drugs for our formulary based on how safe and effective they are, among other factors. The committee meets quarterly to consider changes to the formulary based on new information or new drugs that become available.
Note: The presence of a drug on our drug formulary does not necessarily mean that your plan physician will prescribe it for a particular medical condition.
If there are any changes to the drug formulary or restrictions are added to a drug, and you are taking the drug affected by the change, you will be permitted to continue receiving that drug according to your drug benefit.
Please refer to your Evidence of Coverage for complete details of your prescription drug benefit.
Getting an exception to the formulary
Drugs not listed on the formulary are called non-formulary drugs. When a Kaiser Permanente physician determines that a non-formulary drug is medically appropriate and necessary, that drug will be covered under the terms of your benefits (if you have a prescription drug benefit). If you do not have a prescription drug benefit, you will be charged the full retail price for the drug.
The most effective way to get an exception to the formulary is to send a secure email to your doctor. You and your doctor are best able to determine your medication needs.
You may also contact Member Services by submitting an online form. Or call Member Services, 24 hours a day, 7 days a week at:
- English: 1-800-464-4000
- Spanish: 1-800-788-0616
- Chinese dialects: 1-800-757-7585
- TTY for the hearing and speech impaired: 1-800-777-1370
If you wish to have a non-formulary drug that our physician does not determine to be medically necessary, you may file a grievance (or for Senior Advantage and Medicare Cost members, file an appeal) with Member Services.
For more information about how our drug formulary works (e.g., drug restrictions or plan limitations), please contact our Member Service Contact Center Monday through Friday from 7 a.m. to 7 p.m., or Saturday and Sunday from 7 a.m. to 3 p.m. (except holidays).
- English: 1-800-464-4000 (toll free)
- Spanish: 1-800-788-0616 (toll free)
- Chinese dialects: 1-800-757-7585 (toll free)
- TTY for the hearing and speech impaired: 1-800-777-1370 (toll free)