2016 Find a Medicare Drug

The medications we cover are listed in our Drug List, also known as the formulary. There are two ways to see if your drugs are covered:

You can also look up a drug to see if it is covered in plan year 2016 using our comprehensive online formulary search tool for plan year 2016. This lets you search a comprehensive formulary listing of the drugs we cover. It includes any changes to prior authorization or step therapy rules and is updated whenever changes occur.

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: 

  • Prior Authorization: You [or your physician] need prior authorization for certain drugs. This means that you will need to get approval from FamilyCare Health before you fill your prescriptions.  If you don’t get approval, FamilyCare Health may not cover the drug. Click here for a list of 2016 PA drugs.
  • Quantity Limits: For certain drugs, the there may be limits to the amount of the drug that we will cover. For example, we provide 12 tablets per 30-day prescription for RELPAX.  This may be in addition to a standard one-month or three-month supply. 
  • Step Therapy: In some cases, FamilyCare requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If Drug A does not work for you, we will then cover Drug B. Click here for updates to the 2016 Step Therapy list. 

You can find out if your drug has any additional requirements or limits by looking in the formulary.

If the drug you are being prescribed is not on the formulary or has additional requirements (above), you or your doctor may request a coverage determination/formulary exception. Please see coverage determination/exception form.

How to request an exception for a drug
We want to hear if you have problems getting a Medicare Part D drug, if you want us to pay you back for a Part D drug, or if a drug is not covered in the way you would like it to be covered. 

If you are asking us to make a change just for you to our formulary or our drug tiers, your doctor or other prescriber must give us a statement that explains the medical reasons for “requesting an exception.” Examples of a request for an exception include:

  • Asking us to cover a Part D drug that is not on our list of covered drugs
  • Asking us to waive a restriction on the plan’s coverage for a drug (such as limits on the amount of the drug you can get)
  • Asking to pay a lower cost-sharing amount for a covered non-preferred drug
  • To request an exception specifically for prescription drug coverage, you may use this Medicare Coverage Determination form.

For more information about your rights when we change our formulary (for example if you are taking a drug that was covered differently on the previous formulary), see our Prescription Drug Transition Policy.

Updated 10/1/2015

Y0103_WEB_00142v2 Approved

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