"Are my drugs on the formulary?"
That's one question most people have when choosing a Medicare plan. The Priority Health Medicare Approved Drug List (also called "the formulary") tells you what prescription drugs are covered by any of our Medicare plans that include drug coverage. The drug list also includes each drug's "tier," or cost level.
Jump down this page to see drug tiers and copays for 2010.
3 ways to find out if your drugs are covered
- Search for your drugs in the drug list booklet
Section 2 of the booklet is the list of drugs. An index by drug name begins on page 63. This document will open in a new window.
Section 2: 2010 Approved Drug List (1.3MB PDF)*.
Section 1 will help you "decode" all the required Medicare language in the booklet, and give you answers to frequently asked questions. This document will open in a new window.
Section 1: Introductions and FAQs (471KB PDF)*. - Search our online Approved Drug List
The main Priority Health website is updated daily with the most current listing of drugs. NOTE: This link will open the main Priority Health website in a new window.
Go to the Approved Drug List. - Call our Medicare specialists at 888 389-6676.
More information about what drugs are covered
- You'll receive 60-days' notice if we make a change that affects a drug you are taking.
View pending changes to the approved drug list. - Some drugs are not covered by any Medicare plan.
View a list of drugs that Medicare does not cover. - Some drugs are covered, but have restrictions such as quantity limits or a requirement to try other drugs first (step therapy).
Learn more about these requirements. - If a drug you need isn't on the approved drug list, you can request an exception to our Approved Drug List.
Learn more about asking for a coverage exception. - Learn how we approve drugs for the Approved Drug List, and how you can join a medication management program.
Go to the drug approval process page.
Drug tiers for 2010**
| Tier | Drug type | Drug copay Medicare Advantage plans | Drug copay PriorityMedicare Rx plan |
|---|---|---|---|
| 1 | Generics | $8 (31-day) $20 (mail order 90-day) |
$8 (31-day) $20 (mail order 90-day) |
| 2 | Preferred brand name | $30 (31-day) $75 (mail order 90-day) |
$43 (31-day) $107.50 (mail order 90-day) |
| 3 | Non-preferred brand name | $60 (31-day) $150 (mail order 90-day) |
$79 (31-day) $197.50 (mail order 90-day) |
| 4 | Specialty | 25% of Priority Health's discounted cost | 33% of Priority Health's discounted cost |
**Copays shown are your cost for a 31-day supply at a retail pharmacy/90-day supply through mail order in the Priority Health network, before you reach $2,830 in total drug costs (total of what you pay plus what Priority Health pays). Costs may vary when your plan is provided by an employer.
People on limited incomes may pay less for their drugs. Learn about extra help.
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Updated: November 23, 2009