Drug formulary

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

Individual & Family plans

• 2021 Drug Formulary for Core and Access PPO Plans (PDF)
  (4-Tier Open Formulary Pharmacy Benefit with Specialty Tier)
• Formulary Change Notice (PDF)
  (4-Tier Open Formulary Pharmacy Benefit with Specialty Tier)

Medicare Advantage plans

• 2021 Medicare Advantage Part D Drug Formulary
  For Individual and Group Medicare Advantage members with Part D plans
• 2021 Group Medicare Advantage Drug Formulary (PDF)
  (Commercial 1- or 2-Tier In-Network Pharmacy Benefit) For Group Medicare Advantage members without a Part D plan
• 2021 Group Medicare Advantage Drug Formulary (PDF)
  (Commercial including PEBB 3-Tier In-Network Pharmacy Benefit) For Group Medicare Advantage members without a Part D plan
• 2021 Group Medicare Advantage Drug Formulary (PDF)
  (Commercial including FEHB 5-Tier In-Network Pharmacy Benefit) For Group Medicare Advantage members without a Part D plan
• Formulary Change Notice (PDF)
  (1- or 2-Tier In-Network Pharmacy Benefit)
• Formulary Change Notice (PDF)
  (3-Tier In-Network Pharmacy Benefit)
• Formulary Change Notice (PDF)
  (5-Tier In-Network Pharmacy Benefit)

Federal Employee Health Benefits (FEHB) Program

• 2021 Drug Formulary for Kaiser Foundation Health Plan of Washington FEHB HMO Plans (PDF)
• 2021 Drug Formulary for Kaiser Foundation Health Plan of Washington Options, Inc. Federal Plans (PDF)
• Formulary Change Notice (PDF)

Small employer (1-50) group plans

Drug Formulary for Core and Access PPO Plans

• Contract Year 2021: 4-Tier Open Formulary Pharmacy Benefit with Specialty Tier (PDF)
• Formulary Change Notice (PDF)
  (4-Tier Open Formulary Pharmacy Benefit with Specialty Tier)

Large employer group (51+ employees) plans

• 2021 Drug Formulary for Large Employer Groups (PDF)
  (1- or 2-Tier In-Network Pharmacy Benefit)
• 2021 Drug Formulary for Large Employer Groups (PDF)
  (1 or 2-Tier with Additional Specialty Tier In-Network Pharmacy Benefit)
• 2021 Drug Formulary for Large Employer Groups (PDF)
  (3-Tier In-Network Pharmacy Benefit)
• 2021 Drug Formulary for Large Employer Groups (PDF)
  (4-Tier In-Network Pharmacy Benefit)
• 2021 Drug Formulary for Large Employer Groups (PDF)
  (5-Tier In-Network Pharmacy Benefit)
• Formulary Change Notice (PDF)
  (1- or 2-Tier In-Network Pharmacy Benefit)
• Formulary Change Notice (PDF)
  (3-Tier In-Network Pharmacy Benefit)
• Formulary Change Notice (PDF)
  (4-Tier In-Network Pharmacy Benefit)
• Formulary Change Notice (PDF)
  (5-Tier In-Network Pharmacy Benefit)

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.

• Drug formulary coverage request

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.

• Preventive medications list (PDF)
• Contraceptive coverage and costs (PDF)

Medications limited to specific pharmacies

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

• Drug list and preferred pharmacies (PDF)

Maintenance drugs

Maintenance drugs are used on a continuing basis for the treatment of chronic conditions. Select health plans require that pharmacy benefit maintenance drugs are filled at Kaiser Permanente Washington Mail Order or Kaiser Permanente clinic pharmacies for ongoing health plan coverage.

• Maintenance drug list (PDF)

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.

• Drug list (PDF)