Use the Drug Pricing Quote
- Click on Drug Pricing Quote 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 Get Prices select pharmacy type. For a different pharmacy, change the pharmacy name in the dispensing pharmacy or plan selection.
- Click View Pricing Details to price selected drugs.
- Click View Monthly Budget 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 remove drugs from the SilverScript Medicare Part D 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 U.S. Food and Drug Administration (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 SilverScript Medicare Part D formulary and notify
all affected members as soon as possible.
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,
- 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 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 references.)
Last Updated: 12/2016