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Formulary (list of covered drugs)
A formulary is a list of drugs, or prescriptions, that a plan covers. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. For more information on how to fill your prescriptions, see the Keystone First VIP Choice Evidence of Coverage (PDF — December 19, 2019).
The formulary has been reviewed and approved by the Centers for Medicare & Medicaid Services (CMS), the agency that administers the Medicare Program. Formulary medications are Food and Drug Administration (FDA) approved and have been chosen for their reported medical effectiveness and value. The formulary is updated at times throughout the year, and the list of drugs may change.
Keystone First VIP Choice covers both brand name drugs and generic drugs. Generic drugs have the same active ingredient as brand name drugs. Generic drugs usually cost less than brand name drugs and are rated by the FDA to be as safe and effective as brand name drugs.
Want regular information about your pharmacy benefits? Look out for your monthly explanation of pharmacy benefits in the mail.
Keystone First VIP Choice 2020 drug formulary
- Searchable online formulary
- Printable comprehensive formulary PDF — September 11, 2020
- Prior authorization criteria PDF — September 1, 2020
- Step therapy criteria PDF — September 1, 2020
- Prescription drug frequently asked questions (FAQ)
Answers to commonly asked questions, like "What if my drug is not on the formulary?" and "What are over-the-counter (OTC) drugs?"
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