Here's where to learn which drugs your plan covers. You can also see whether a drug is brand-name or generic and learn of any restrictions for its use.
Drug lists are reviewed monthly. Latest update: 3/1/2024
2023 and 2024 Plan Members:
Important Message About What You Pay for Vaccines – Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible.
Important Message About What You Pay for Insulin – You won't pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it's on, even if you haven't paid your deductible.
For a complete, printable drug list, choose "View/Print Drug List" at left.
Save money with CVS Caremark mail order.
Select Care (Tier 6) drugs are included in your prescription plan, and you'll pay $0 for up to a 90-day supply at preferred pharmacies. These drugs treat conditions related to blood pressure, cholesterol, diabetes, and more.
Note: Does not apply to PERS plan. See PERS drug list at left.
PacificSource Medicare plans cover both brand and generic drugs. Generic drugs have the same active ingredient as a brand-name drug. Generics usually cost less and are determined by the Food and Drug Administration (FDA) to be as safe and effective as their brand-name counterparts.
For certain prescriptions there are additional requirements or limits. Learn more about utilization management, including prior authorization, quantity limits, and step therapy:
You and your doctor have the right to request an exception to the plan’s formulary or coverage criteria. If your drug is not included in this drug search, you should first contact Customer Service and confirm that your drug is not covered. If you learn that your PacificSource Medicare plan does not cover your drug, you have two options:
To help ensure the safety of our members, PacificSource Medicare has adopted a Drug Utilization Review and Medication Error Identification and Reduction policy.
The list of covered drugs (formulary) may change at any time. You will receive notice when necessary. Other pharmacies are available in our network.