The Care1st Health Plan Formulary lists drugs, in consultation with a team of health care providers, that represent the prescription therapies believed to be a necessary part of a quality treatment program. Our Care1st Health Plan Comprehensive Formulary lists drugs that are available to Care1st members.
Care1st Health Plan will generally cover the drugs listed in our formulary as long as 1) the drug is medically necessary, 2) the prescription is filled at a Care1st Health Plan network pharmacy, and 3) other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Care1st Health Plan covers 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.
The Medicare program allows us to make changes in our prescription drug formulary list any time during the calendar year. A change in our drug formulary could affect which drugs are covered, the member's copayment and the limit on usage.
An exception is a permission to get coverage for a drug that is not normally on our List of Covered Drugs, or to use the drug without certain rules and limitations. If a drug is not on our List of Covered drugs, or is not covered in the way you would like, you can ask us to make an "exception". When you ask for an exception, your doctor or other prescriber will need to explain the medical reasons why you need the "exception".
For more information please review your Evidence of Coverage (EOC) document, Chapter 9 Section 6.2.
Below is the HPMS Approved Formulary 18421, Version 6 available for download:
Care1st Health Plan contracts with pharmacies that equal or exceed CMS requirements