Physicians: Quickly locate Medicare Part D formularies for your patients.

SXC Medicare Prescription Drug Plans

Medicare Part D Comprehensive Formulary Listings

Select a formulary from the list below to find the most up-to-date listing of covered drugs for your patient's Medicare Prescription Drug Plan.

NOTE: Patients currently using a medication that has or will be removed from the formulary, has new coverage requirements or limits, or that is moved to a drug tier with a higher co-payment or co-insurance will be notified by mail at least 60 days prior to the change. Please keep in mind that if the Food and Drug Administration finds that a drug on the formulary is unsafe or if the drug's manufacturer removes the drug from the market, we immediately remove the drug from our formulary and then notify the member of the change

An Exception to the Coverage Rules Can Be Requested

A member may request an exception to the coverage rules. There are several types of exceptions that we can be asked to make:

• The member can request to cover a drug even if it is not on our formulary
• The member can request to waive coverage restrictions or limits on a drug. For example, there are limits on the amount of certain drugs that are covered. If their drug has a quantity limit, they can request to waive the limit and cover more.
• The member can request to provide a higher level of coverage for their drug. If their drug is contained in a non-preferred tier, they can request to cover it at the cost-sharing amount that applies to drugs in a preferred tier instead. This would lower the amount due.

Generally, the plan will only approve a request for an exception if the alternative drugs included on the plan's formulary would not be as effective in treating the member's condition and/or would cause the member to have adverse medical effects.

Members may contact their plan for an initial coverage decision for a formulary exception. When requesting an exception, the member should submit a statement from their physician supporting their request. Generally, a decision is made within 72 hours of their request.