Drug Formulary

Kaiser Permanente's drug formulary is a list of medications covered by your health plan.

Individual & Family, and Small Employer Group Plans

Information about prescription drug plans and a list of medications available to members in our individual and family plans, or in small employer group (1-50 employees) plans.

Medicare Advantage Plans

List of drugs selected by Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. — and approved by the Centers for Medicare and Medicaid Services (CMS) — that are covered by Kaiser Permanente's Medicare Advantage prescription drug plans.

Federal Employee Health Benefits Program

Information about prescription drug plans and a list of medications available to employees and retirees in the Federal Employee Health Benefits (FEHB) program.

Large Employer Group Plans

Information about prescription drug plans and a list of medications available to members in our large employer group (51+ employees) plans.

Prior Authorization and Nonformulary Drug Exception Requests

You or your doctor can request coverage for prior authorization drugs or nonformulary drugs. Your request will be reviewed based on our coverage criteria or medical necessity. If we approve the request, you will pay a cost share determined by your member contract. If we do not approve the request, you may still choose to get the medication and pay full price. For more information, see About Our Drug Formulary.

Preventive Medications and Preferred Contraceptives

Most plans cover Affordable Care Act (ACA) requirements for preventive care medicines and contraceptives in full. Please consult your Benefit Booklet under "Preventive Services" or call Member Services if you have questions about your coverage for these drugs.

Specialty Medications List and Preferred Pharmacies

Some drugs are limited to either Kaiser Permanente Specialty Medication Pharmacy or BriovaRx Specialty Medication Pharmacy. Limitations only apply to the pharmacy benefit, not the medical benefit. Limitations do not apply to Medicare.

Medical Benefit Injectable Drugs Requiring Prior Authorization

Some drugs covered under the medical benefit require prior authorization. These limitations apply to a select group of medications that need to be given in a non-hospital setting such as home infusion, a medical center, a physician's office, or an infusion suite. These limitations do not apply to Medicare.