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Formulary

The PARTNERS Medicare prescription drug list is based on a preferred list of FDA-approved prescription drugs and was developed using guidelines from the federal government. The drug list includes more than 3,700 drugs, including generic, brand name and specialty drugs. Many of the most popular prescriptions are included. Certain vaccinations, insulin and insulin injection supplies are also covered. Over-the-counter drugs are not covered because, they are excluded by Medicare.

PARTNERS Medicare 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 Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

To determine if your drugs are covered by PARTNERS, click the button below to search the drug list.

Tips for using the drug list

• Drug tiers - Drugs are assigned into three payment categories, based on usage, cost and clinical effectiveness.
• Prior authorization and quantity limitations - To encourage the appropriate use of prescription drugs, some quantities are limited and some drugs must be approved before PARTNERS will cover them.
• Formulary changes - The PARTNERS formulary may change from time to time. These changes may include the removal of a drug from the formulary or a change in the payment level.
• 60-day notice – If you are affected by a change to the formulary, you will be notified in writing at least 60 days prior to the change.
•  Limitations and exclusions - Like most insurance coverage, our Medicare Prescription Drug Plans have some conditions and limitations.
• If you can't find your drug - If you do not find your drug in the formulary, PARTNERS may not cover your drug. To verify whether your drug is covered, please call Customer Service toll-free at 1-888-310-4110, 7 days a week, 8 a.m. to 8 p.m (TDD/TTY 1-888-451-9957).
• If your drug is not covered - If PARTNERS does not cover your drug, you have the right as a member to request that an exception be made to the formulary or to request a transition supply, while you find an appropriate alternative prescription.
  
  For instructions on how to request a transition supply or an exception to the formulary, and instructions on how to appeal a decision about an exception or to file a grievance if you are dissatisfied for any reason, please review the following documents:
  • Transition process
  • Coverage determination
  • Appeals process
  • Grievance procedures

Note: Medicare-eligible retirees (and covered dependents) of Reynolds American Inc. or one of its Designated Affiliates (RAI), visit the RAI member page.