Medicare Advantage (HMO) Part D Drug Formulary

Kaiser Permanente Drug Coverage

This formulary is a list of drugs selected by Kaiser Foundation Health Plan of Washington —and approved by the Centers for Medicare & Medicaid Services (CMS)—that are covered by Kaiser Permanente Medicare Advantage plans that include prescription drugs. Based on consultation with a team of health care providers, these prescription therapies are believed to be a necessary part of a quality treatment program.

Drugs are classified into six tiers. Learn more about Part D coverage.

2018 Formulary

2018 Medicare Advantage Part D Comprehensive Formulary (PDF)

(Go to the Formulary to download a PDF of our 2018 Medicare Advantage Part D Comprehensive Formulary. You can view it online or print a copy anytime. To request a printed formulary, contact Member Services at 1-888-901-4600 or TTY WA Relay 1-800-833-6388 or 711, 8 a.m. - 8 p.m., 7 days a week.)

Please note: Kaiser Permanente health plans require prior authorization for certain drugs. Here is the prior authorization drug list (PDF) for 2018.

In some cases, Kaiser Permanente requires you to first try certain drugs to treat your medical condition before covering another drug for that same condition. See 2018 Step Therapy Requirements. (PDF)

Kaiser Permanente Medicare Advantage plans may add or remove drugs from the formulary during the year. The formulary on this page is current as of Jan. 1, 2018.

Generally, if you are taking a drug that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when we receive information from the FDA that a drug is no longer safe or effective. Complete information about these changes is included in the formulary documents above.

Kaiser Permanente Medicare Advantage plans cover 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 Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Also see: Formulary Change Policy (PDF)

If a drug isn't covered. If your doctor or pharmacist says that a certain prescription drug is not covered, call Member Services to ask why the drug was not covered. Here are other steps you can take:

  • Talk to your doctor about alternative drugs that are on the Medicare Advantage Part D formulary.
  • Ask your doctor to adhere to rules about quantity limits and prior authorization.
  • Ask your pharmacist to recommend a prescription change to the doctor. Form: Request for Prescription Information or Change (PDF)
  • If you would like to ask for a drug formulary exception from Kaiser Permanente, you can do so via phone, fax, mail, or online.

Also see: formulary exceptions information page

Call Member Services

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Forms, Policies, and Resources

Information for Current Members

Questions? Call Us

Prospective members
(to be directed to a licensed sales specialist)
8 a.m. - 8 p.m., 7 days a week
TTY WA Relay 1-800-833-6388 or 711

Current members
8 a.m. - 8 p.m., 7 days a week
TTY WA Relay 1-800-833-6388 or 711

Medicare Star Quality Ratings

Our Medicare Advantage health plan in Washington was rated 4.5 out of 5 stars for 2018. Our 4.5 out of 5 star rating is based on quality, service, and member satisfaction, so you get the peace of mind that comes with knowing you're getting high-quality care. 1

NCQA Excellent Accreditation

Kaiser Permanente Washington Medicare Advantage (HMO) plan was rated 5 out of 5 in the National Committee for Quality Assurance (NCQA) Medicare Health Insurance Plan rankings 2017-2018.2