Drug Formulary

Kaiser Permanente's drug formulary is a list of medications covered by your health plan.

Individual & Family, and Small Employer (1-50) Group Plans

Medicare Advantage Plans

Federal Employee Health Benefits (FEHB) Program

Large Employer Group (51+ Employees) Plans

Prior Authorization and Nonformulary Drug Exception Requests

You or your doctor can request coverage for prior authorization drugs or nonformulary drugs. Requests are reviewed based on our coverage criteria or medical necessity. If we approve a request, you pay a cost share determined by your member contract. If we do not approve the request, you can get the medication and pay full price. See About Our Drug Formulary.

Preventive Medications and Preferred Contraceptives

Most plans cover Affordable Care Act requirements for preventive care medicines and contraceptives in full. For questions, see "Preventive Services" in your Benefit Booklet or call Member Services at 1-888-901-4636.

Specialty Medications List and Preferred Pharmacies

Some drugs are limited to either Kaiser Permanente Specialty Medication Pharmacy or BriovaRx Specialty Medication Pharmacy. Limitations only apply to the pharmacy benefit, not the medical benefit. Limitations do not apply to Medicare.

Medical Benefit Injectable Drugs

Some drugs are given in a non-hospital setting such as home infusion, a medical office, a physician's office, or an infusion suite. These drugs are covered under the medical benefit but may require prior authorization or a non-hospital setting. These limitations do not apply to Medicare.