Formulary Drug List
If you sign up for our MA Pharmacy Plan, MA Extra Plan, or the MA Special Needs Plan you will receive coverage for the prescription drugs on our Formulary list and not pay a deductible. The Comprehensive Formulary provides you with a list of drugs covered and their cost sharing tier and any additional requirements or limitations. The Formulary might change during the course of the year.
Prescription Drug Search
To search for a specific drug, simply open the Formulary Drug List PDF below, click on the Search Function tool bar at the top represented by a binocular icon, type the name of the drug you wish to search for in the box that appears on the top right-hand side of the page and click Search.
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2013 One-Tier Formulary:
- Comprehensive Formulary
- 2013 Prior Authorization Criteria
- 2013 Step Therapy Criteria
- 2013 Quantity Limits
- Notice of Formulary Drug List Changes
2013 Three-Tier Formulary:
- Comprehensive Formulary
- 2013 Prior Authorization Criteria
- 2013 Step Therapy Criteria
- 2013 Quantity Limits
- Notice of Formulary Drug List Changes
Didn't find what you were looking for?
If your drug is not listed in the formulary, you should first contact Customer Service and ask if your drug is covered, 8:00 a.m. to 8:00 p.m., 7 days a week at 1-800-942-0247 (TTY Relay: 7-1-1). If you learn that Community HealthFirst does not cover your drug, you have options:
We realize that situation may arise where you may need to access drugs that are not on the formulary or cases in which you need a refill sooner than expected. We call this a Plan Transition Process and have taken into account these special circumstances.
Questions about Prescription Drug coverage?
If you have any questions about our Formulary Drug List, tiering, copay levels or policies, please call Customer Service, 8:00 a.m. to 8:00 p.m., 7 days a week. Current Members should call 1-800-942-0247 (TTY Relay: 7-1-1). Prospective Members should call 1-800-944-1247 (TTY Relay: 7-1-1). Or you can send questions to Community HealthFirst, PO Box 960, Seattle, WA 98111-0960.
Note about Brand Name Drugs and Generic Drugs
Community HealthFirst covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
Quality Assurance Policies and Procedures
It is Community HealthFirst’s policy to emphasize the quality of your pharmaceutical care. Our goal is to provide you with the most effective and affordable medications available to improve your health.
We use the best research and evidence available in developing our formulary to ensure that you have access to cost-effective medications.
We offer a medication therapy management program to qualified members. This program is intended to optimize the drug therapy for our members who have the following chronic conditions: asthma, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), depression, diabetes, high blood cholesterol, high blood pressure and osteoporosis. These programs may have limited eligibility criteria. If you have questions about the medication therapy management program, please call Customer Service, 8:00 a.m. to 8:00 p.m., 7 days a week. Current Members should call 1-800-942-0247 (TTY Relay: 7-1-1). Prospective Members should call 1-800-944-1247 (TTY Relay: 7-1-1).