2023 Medicare HealthPartners Formulary I

Welcome

We cover both brand name drugs and generic drugs. 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.

What is a Formulary?

A formulary is a list of drugs that are covered by an insurance plan. These drugs represent the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Print the 2023 Medicare drug lists

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• 2023 Formulary I Drug List (PDF) (Last Updated 12/2023)
• Prior Authorization criteria (PDF) (Last Updated 12/2023)
• Step Therapy criteria (PDF) (Last Updated 12/2023)
• Formulary Change Notice (PDF) (Last Updated 06/2023)


How to Search For Drugs?


• Search by typing the first part of the generic (chemical) and brand (trade) names.
• Search by selecting the therapeutic class of the medication you are looking for.
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Products matching the search terms will display. Drugs that are on the List of Covered Drugs (Formulary) will display with tier status and limits and restrictions such as Prior Authorization, Quantity Limits, or Step Therapy requirements. Drugs that are not included on the List of Covered Drugs will display as “NF” (not on the formulary).

How to Request an Exception

If your drug is not on our formulary, you can request a coverage decision or exception by completing the Coverage Determination Form.

Please see the Drug Management Programs section of the Evidence of Coverage for information about our quality assurance policies and procedures, including Medication Therapy Management and drug utilization.