SilverScript Drug List

A Drug list (Formulary) is a list of drugs covered by a plan. Formularies are developed to meet the needs of most members based on the most commonly prescribed drugs, including certain prescription drugs required by Medicare. The SilverScript formulary is updated throughout the plan year and may change if:

• The plan no longer covers a drug.
• A new drug is added.
• A drug is moved to a different cost-sharing Tier.
• A Prior Authorization, Step Therapy restriction or Quantity Limit has been added or changed for a drug.
• A drug is removed from the market by either the manufacturer or the Food and Drug Administration (FDA) for safety reasons.

SilverScript 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 U.S. Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

We may remove drugs from the formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug, and/or move a drug to a higher cost-sharing tier during the plan year. If the change affects a drug you take, we will notify you at least 60 days before the change is effective. However, if the FDA deems a drug on our formulary to be unsafe, or if the drug's manufacturer removes the drug from the market, we may immediately remove the drug from the formulary and notify all affected members as soon as possible.

Drugs Not Covered by Your Medicare Part D Prescription Drug Plan

Federal law prohibits your Medicare Part D Prescription Drug plan from covering certain types of drugs, including:

• Non-prescription drugs (also called over-the-counter drugs).
• Drugs when used for treatment of anorexia, weight loss or weight gain.
• Drugs when used to promote fertility.
• Drugs when used for cosmetic or hair growth purposes.
• Drugs when used for the relief of cough or cold symptoms.
• Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations).
• Drugs when used for the treatment of sexual or erectile dysfunction (ED).
• Outpatient drugs for which the manufacturer seeks to require that associated tests or monitoring services be purchased exclusively from the manufacturer as a condition of the sale.
• Barbiturates except when used to treat epilepsy cancer or a chronic mental health disorder.

In addition, Medicare Prescription Drug plans are unable to cover the following:

• Drugs that would be covered under Medicare Part A or Part B. Some drugs are covered under Medicare Part B in certain cases and under Medicare Part D in others. In most cases, your pharmacist or provider will appropriately determine whether to bill Medicare Part B or Part D for your drug.
• Drugs not approved by the U.S. Food and Drug Administration (FDA) or that are purchased outside the United States and its territories.
• Off-label use, in many cases, where a drug is used in any way other than those indicated on a drug's label as approved by the Food and Drug Administration. (Generally, coverage for "off-label use" is allowed only when use is supported by certain reference books.)

Drug Search Tool

This tool lets you access the full list of drugs covered by our plans. It also allows you to estimate pricing information and to estimate an annual budget of your drug costs. To use our Drug Search Tool, please follow these steps:

1. Choose the Drug and Pricing Tools button in the upper middle navigation bar and select Drug Search Tool.
2. Select your state from the pull down menu and click the red Review Available Plans button.
3. Choose one of the plans you wish to view.
4. Select your state from the pull down menu.
5. Enter your ZIP Code.
6. Enter the name(s) of your drugs. There is a 2 character minimum so be sure to have a list of your prescription drugs nearby. You will also need to select the drug form, strength and the dosage. Click the "add to list" button, and repeat if necessary until your list is complete. Select a type of pharmacy and click "get prices".
7. When your list is complete, compare the coverage for your drug list under any of the plans we offer.
8. If you would like to select a different pharmacy, change the pharmacy name in the dispensing pharmacy or plan selection in the upper right hand corner of your screen.
9. If the drug you selected is not covered by the plan, either select a different strength of the drug or click the Alternatives Available link if it is listed.
10. When finished, click on the X in the upper bar of the pop-up box to close your window.

After entering drug names, select the dosage and the number of doses you take per day. Then click the "add to list" button. When you have entered all of the drugs you may print a list by clicking the "Print List" in the top right hand corner of the screen.

If you would like to select a different plan you may do so using the plan selection at the top of the page.

Last Updated: 05/2013
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Drug Pricing Tool

This tool lets you access to the full list of drugs covered by our plans. It also allows you to estimate pricing information and estimate an annual budget of your drug costs. To use our Drug Pricing Tool, please follow these steps:

1. Choose the Drug and Pricing Tools button at the top of the page, then select Drug Pricing Tool.
2. Select your state from the pull down menu.
3. Enter your ZIP Code.
4. Click the red next button.
5. Enter the name(s) of your drugs. There is a 2 character minimum so be sure to have a list of your prescription drugs nearby. You will also need to select the drug form, strength and dosage. Click the "add to list" button, and repeat if necessary until your list is complete. Select a type of pharmacy and click "get prices".
6. When your list is complete, compare the coverage for your drug list under any of the plans we offer.
7. If you would like to select a different pharmacy, change the pharmacy name in the dispensing pharmacy or plan selection in the upper portion of your screen.
8. If the drug you selected is not covered by the plan, either select a different strength of the drug or click the Alternatives Available link if it is listed.
9. You may view the pricing details or the estimated monthly budget for your chosen drugs by clicking the respective button.
10. When finished, click on the X in the upper bar of the pop-up box to close your window.

After entering drug names, you'll be asked to select the dosage and the number of doses you take per day. Click the "add to list" button. When all the drugs have been entered, click "Print List" in the top right hand corner of the screen to print a complete list.