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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 (EOC) (PDF).
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 2024 drug formulary
- Searchable online formulary
- Printable comprehensive formulary (PDF) PDF
- Machine-readable list of covered drugs (is in accordance with CMS standard) (JSON) JSON
- Prior authorization criteria (PDF) November 28, 2023 PDF
- Step therapy criteria (PDF) November 28, 2023 PDF
- 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?"
- Find a pharmacy
- View and/or print the formulary updates (PDF) November 28, 2023 PDF
- Preferred diabetic supplies (PDF) PDF
Please find updates to Preferred Diabetic Supplies effective January 1, 2024. For questions, please contact Member Services at 1-800-450-1166 (TTY 711), 8 a.m. – 8 p.m., Monday through Friday, from April 1 to September 30. From October 1 to March 31, 8 a.m. – 8 p.m., seven days a week.