Our prescription drug coverage is accepted at more than 1,000 Washington State pharmacies and more than 50,000 pharmacies nationwide.
Search our list of covered drugs, browse our pharmacy directory, and more. You will need Adobe Acrobat Reader to view the PDF documents on this website. Download Adobe Acrobat Reader for free.
Formularies and Pharmacies (2018 Plans)
- Tier One Formulary (English and Spanish Combined) (PDF) (Special Needs Plan 014)
- Tier One Online Searchable Formulary (Special Needs Plan 014)
- Tier Five Formulary (English and Spanish Combined) (PDF) (Plans 008, 009, and 010)
- Tier Five Online Searchable Formulary (Plans 008, 009, and 010)
- Notices of Changes to Formularies
- Pharmacy Directory
Formularies for 2019 Plans
- Tier One Formulary PDF English and Spanish combined (Special Needs Plan 014)
- Tier Five Formulary PDF English and Spanish combined (Plans 008, 009, 010, 016)
New Limits for Opioid Prescriptions from CMS
Starting on January 1, 2019, there will be new limits on opioid prescriptions for members who have Medicare Part D. This change follows guidance from the Centers for Medicare & Medicaid Services (CMS).
- Members who are filling a first-time prescription for opioids to treat acute pain won’t be able to get more than a seven-day supply at one time.
- Pharmacists will be required to consult with the prescriber for opioid prescriptions greater than 90 morphine equivalent dose (MME) per day.
These limits don’t apply to members who:
- Live in a long-term care facility.
- Are in hospice and receiving end-of-life care.
- Are being treated for active cancer-related pain.
- Are prescribed buprenorphine products for medically assisted treatment (MAT).
CMS recommends more oversight and monitoring of opioid prescription to address current trends and safety concerns. Medication reviews may result in a member being assigned to a single pharmacy and a single subscriber for controlled substances in order to better coordinate care and case management.
To read more about changes to opioid prescriptions for Medicare Part D members in 2019, please see the CMS Factsheet: https://www.cms.gov/newsroom/fact-sheets/2019-medicare-advantage-and-part-d-rate-announcement-and-call-letter
Step Therapy Criteria
- 2018 Step Therapy Criteria
- 2018 Prior Authorization Criteria
- 2019 Step Therapy Criteria
- 2019 Prior Authorization Criteria
Pharmacy Forms, Programs, and Policies
- Medication Therapy Management Program
- How to Request Coverage Exceptions, Determinations, and Redeterminations
- Prescription Drug Claim Form
- Plan Transition Policy | Español
The following 2018 plans include Part D prescription drug coverage:
- MA Special Needs Plan 014 (HMO SNP)
- MA Pharmacy Plan 008 (HMO)
- MA Pharmacy Plan 009 (HMO)
- MA Extra Plan 010 (HMO)
**Please note that MA Plan 006 (HMO) does not offer prescription drug coverage.
Be sure to read our Drug Recalls Report for updates on medications that are recalled due to the safety issues.
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).
The formularies may change at any time. You will receive notice when necessary.