Formulary Drug List
If you sign up for our MA Pharmacy Plan, MA Extra Plan, MA Premium 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.
2012 Three-Tier Formulary:
Comprehensive Formulary
2012 Prior Authorization Criteria
2012 Step Therapy Criteria
2012 Quantity Limits
Transition Letter for MA Pharmacy Plan (HMO): English | Español
Transition Letter for MA Enhanced Pharmacy Plan (HMO): English | Español
2012 Four-Tier Formulary:
Comprehensive Formulary
2012 Prior Authorization Criteria
2012 Step Therapy Criteria
2012 Quantity Limits
Requesting exceptions to the Formulary Drug List and coverage policies/procedures.
If your drug is not listed in the formulary, you should first contact Customer Service and ask if your drug is covered. If you learn that Community HealthFirst™ does not cover your drug, you may request an exception be made for coverage of that drug. You may also ask us to waive coverage restrictions or limits on a drug.
- You can ask us to cover your drug even if it is not on our formulary.
- You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Community HealthFirst™ limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover more.
Generally, Community HealthFirst™ will only approve your request for an exception if the alternative drugs included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.
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.
Plan Transition Process.
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
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).