Drug formulary (covered drugs)

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

 

2024 Drug Formulary for Core, Connect, and Access PPO Plans (PDF)
4-Tier Open Formulary Pharmacy Benefit with Specialty Tier

Formulary Change Notice (PDF)
4-Tier Open Formulary Pharmacy Benefit with Specialty Tier

 

 

2024 Medicare Advantage Part D Drug Formulary
For Individual and Group Medicare Advantage members with Part D plans.

2024 Group Medicare Advantage Drug Formulary (PDF)
Commercial 1- or 2-Tier In-Network Pharmacy Benefit. For Group Medicare Advantage members without a Part D plan.

2024 Group Medicare Advantage Drug Formulary (PDF)
Commercial including PEBB 3-Tier In-Network Pharmacy Benefit. For Group Medicare Advantage members without a Part D plan.

2024 Group Medicare Advantage Drug Formulary (PDF)
Commercial including FEHB 5-Tier In-Network Pharmacy Benefit. For Group Medicare Advantage members without a Part D plan.

Formulary Change Notice (PDF)
1- or 2-Tier In-Network Pharmacy Benefit

Formulary Change Notice (PDF)
3-Tier In-Network Pharmacy Benefit

Formulary Change Notice (PDF)
5-Tier In-Network Pharmacy Benefit

 

 

2024: 4-Tier Open Formulary Pharmacy Benefit with Specialty Tier (PDF)

Formulary Change Notice (PDF)
4-Tier Open Formulary Pharmacy Benefit with Specialty Tier

 

 

2024 Drug Formulary for Large Employer Groups (PDF)
1- or 2-Tier In-Network Pharmacy Benefit

2024 Drug Formulary for Large Employer Groups (PDF)
1 or 2-Tier with Additional Specialty Tier In-Network Pharmacy Benefit

2024 Drug Formulary for Large Employer Groups (PDF)
3-Tier In-Network Pharmacy Benefit

2024 Drug Formulary for Large Employer Groups (PDF)
4-Tier In-Network Pharmacy Benefit

2024 Drug Formulary for Large Employer Groups (PDF)
5-Tier In-Network Pharmacy Benefit

Formulary Change Notice (PDF)
1- or 2-Tier In-Network Pharmacy Benefit

Formulary Change Notice (PDF)
3-Tier In-Network Pharmacy Benefit

Formulary Change Notice (PDF)
4-Tier In-Network Pharmacy Benefit

Formulary Change Notice (PDF)
5-Tier In-Network Pharmacy Benefit

 

 

You or your doctor can request coverage for prior authorization drugs or nonformulary drugs. Requests are reviewed based on our coverage criteria or medical necessity. If we approve a request, you pay a cost share determined by your member contract. If we do not approve the request, you can get the medication and pay full price. See about our drug formulary.

Drug formulary coverage request

 

 

Most plans cover Affordable Care Act requirements for preventive care medicines and contraceptives in full. For questions, see "Preventive Services" in your Benefit Booklet or call Member Services at 1-888-901-4636.

Preventive medications list (PDF)

Contraceptive coverage and costs (PDF)

 

 

Some drugs are limited to either Kaiser Permanente Specialty Medication Pharmacy, Kaiser Permanente Specialty Home Infusion Pharmacy, BriovaRx Specialty Medication Pharmacy or the WA Institute for Coagulation Pharmacy. Limitations do not apply to Medicare.

Pharmacy benefit drug list and preferred pharmacies (PDF)

Medical benefit drug list and preferred home infusion pharmacies (PDF)

 

 

Maintenance drugs are used on a continuing basis for the treatment of chronic conditions. Select health plans require that pharmacy benefit maintenance drugs are filled at Kaiser Permanente Washington Mail Order or Kaiser Permanente clinic pharmacies for ongoing health plan coverage.

Maintenance drug list (PDF)

 

 

Some drugs are given in a non-hospital setting such as home infusion, a medical office, a physician's office, or an infusion suite. These drugs are covered under the medical benefit but may require prior authorization or a non-hospital setting. These limitations do not apply to Medicare.

Drug list (PDF)