Use the Drug Coverage & Pricing Tool
- Click on Drug Coverage & Pricing Tool and then enter your ZIP Code.
- Enter drug name(s).
- Select the drug form, strength and dosage. Repeat to create a list.
- If a drug is not covered, try selecting a different drug strength, or click Alternatives Available if it appears.
- Click Price This Drug List and select pharmacy type and day’s supply. For a different pharmacy, change the pharmacy name in the dispensing pharmacy or plan selection.
- Click Get Prices to price selected drugs.
- Click View Monthly Costs for a budget estimate.
SilverScript Medicare Part D Formulary
A Medicare Part D 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 that Medicare requires that we cover. The SilverScript Medicare Part D formulary is approved by Medicare and 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.
SilverScript covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as their brand name equivalents. 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 immediately remove a brand-name drug on our Drug List if we are replacing it with a new generic drug that will appear on the same or lower cost-sharing tier and with the same or fewer restrictions. Or, when adding the new generic drug, we may decide to keep the brand-name drug on our Drug List, but immediately move it to a different cost-sharing tier or add new restrictions. We may not tell you in advance before we make that change, but we will later provide you with information about the specific change(s) we have made. Also, if the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we may immediately remove the drug from our formulary and later provide notice to members who take the drug.
Before we make other changes during the year to our Drug List that affect members currently taking a drug and require us to provide advance notice, we will notify affected members of the change at least 30 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 30-day supply of the drug.
Drugs Not Covered by Your SilverScript Medicare Part D Formulary
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).
- Covered outpatient drugs which the manufacturers seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee.
In addition, Medicare Part D 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 provide information to your plan to 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 references.)