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Drugs Covered by Medicare Plans

Senior man sitting at the table taking his medicine.

Which Drugs Are Covered by My Medicare Advantage Plans?

 

2025 Medicare Formularies

A formulary is the list of prescription drugs covered by ConnectiCare under your plan. If a drug is not in the formulary, then it is not covered (exceptions may apply). A complete list of covered drugs is available below.

  • 2025 ConnectiCare Medicare Advantage Drug Formulary

  • 2025 ConnectiCare Medicare Advantage D-SNP Drug Formulary

 

2025 Pharmacy Documents

  • Prior Authorization List

    Prior authorization means that you will need to get approval from your plan before you fill your prescriptions. If you do not get an approval, your plan may not cover the drug. Here’s a list of drugs that require prior authorization.

  • Step Therapy

    Step therapy means you may need to try a different or more common drug first. This document lists the drugs that require step therapy.

     

  • Part B Step Therapy

    This document lists Non-Preferred Part B drugs that require step therapy.

     
 

2025 Pricing a Drug

Price a Drug or Locate a Pharmacy

  • ConnectiCare Passage Plan 1 (HMO-POS), ConnectiCare Flex Plan 3 (HMO-POS), ConnectiCare Choice Plan 3 (HMO-POS)

  • ConnectiCare Choice Plan 1 (HMO-POS), ConnectiCare Flex Plan 2 (HMO-POS)

  • ConnectiCare Choice Dual (HMO-POS D-SNP) Plan

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new payment option for 2025 that works with your current Part D drug coverage to help you manage your out-of-pocket prescription costs by spreading them across the calendar year (January through December). Those who have high cost-share amounts for prescription drugs earlier in the plan year are more likely to benefit from the program. This voluntary program is free to join and there are no fees or interest charged under the payment plan.

This option doesn’t save you money or lower your maximum out-of-pocket drug cost ($2,000 in 2025). If you receive extra help paying for prescription drugs or have low drug costs, this payment option is not the best choice for you. Learn more about Extra Help here.

How is the monthly payment calculated? 

The following resources provide examples of how the payment is calculated and tell you about other ways to save on prescription drug costs:

You can also calculate your monthly payment plan amounts here.

How can I opt in or out of the program? 

Contact ExpressScripts to opt in or out of the program.

When does the payment plan go into effect?

If you are new to the plan, we will process your request within:

  • 10 calendar days of receipt of your election form.
  • If your enrollment in our plan will start sooner than 10 days from when we receive your election form, we will process your election before your enrollment in our plan starts so that you will be enrolled in the program on the same day that your plan starts.

If you are currently a member:

  • We will process your request within 24 hours, but enrollment will be effective on the date we receive your completed request.
  • If you paid any cost-share for an urgently needed prescription before we processed your election, we may make your election effective before we receive it. This can happen if you meet the following criteria:
    • You believe that taking 24 hours to process your request may seriously jeopardize your life, health, or ability to regain maximum function.
    • You request a retroactive election within 72 hours of the date and time you paid and received your urgently needed prescription. 

You must pay your monthly payments to stay enrolled. If you do not pay within a grace period of two months, we will remove you from the Medicare Prescription Payment Plan.

For information on how to file a complaint and grievance, please click here.

 

2024 Medicare Formularies

A formulary is the list of prescription drugs covered by ConnectiCare under your plan. If a drug is not in the formulary, then it is not covered (exceptions may apply). A complete list of covered drugs is available below.

  • 2024 ConnectiCare Medicare Advantage Drug and D-SNP Formulary

    Last Updated: 11/01/2024
 

2024 Pharmacy Documents

  • Prior Authorization List

    Prior authorization means that you will need to get approval from your plan before you fill your prescriptions. If you do not get an approval, your plan may not cover the drug. Here’s a list of drugs that require prior authorization.

     

     Last Updated: 11/01/2024

  • Step Therapy

    Step therapy means you may need to try a different or more common drug first. This document lists the drugs that require step therapy.

     

     Last Updated: 11/01/2024

  • Part B Step Therapy

    This document lists Non-Preferred Part B drugs that require step therapy.

     
 

2024 Pricing a Drug

Price a Drug or Locate a Pharmacy

  • ConnectiCare Passage Plan 1 (HMO-POS), ConnectiCare Flex Plan 3 (HMO-POS), ConnectiCare Choice Plan 3 (HMO-POS)

  • ConnectiCare Choice Plan 1 (HMO-POS), ConnectiCare Flex Plan 2 (HMO-POS)

  • ConnectiCare Choice Dual (HMO-POS D-SNP) Plan,  ConnectiCare Choice Dual Vista (HMO-POS D-SNP)

Coverage Determination

Prescription Drug Coverage Determinations

You have the right to request a coverage determination, including the rights to:

  • request an exception,
  • request prior authorization, step therapy and/or quantity limits approval, or
  • get a non-preferred drug at a better out-of-pocket cost

Initial coverage determination is the process we use to decide whether we will cover the Part D drug based on one or more of the following factors and what the cost-sharing amounts will be:

  • medical necessity;
  • drugs not on the formulary;
  • drugs provided by an out-of-network pharmacy;
  • drugs that are benefit exclusions; and
  • drugs requested as exceptions.

You may call our member services at 800-224-2273 (TTY: 711). From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Saturday. Or you can use the prescription drug coverage determination (Y0026_201899_C) form. (solicitud de determinacion de cobertura de medicamentos de receta de Medicare)

You can submit your request for a prescription drug coverage determination to us in one of the following ways:

  • CALL:  800-224-2273 (TTY: 711) From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Saturday.
  • FAX: 877-251-5896
  • WRITE:
    • Express Scripts
      Attn: Medicare Reviews
      P.O. Box 66571
      St. Louis, MO 63166-6571
  • ONLINE: Express Scripts Coverage Determination

Formulary Exceptions

An exception is a type of coverage determination. You may ask for an exception if you need a drug that is not on our list of covered drugs. You may also ask for an exception to rules, such as a limit on the quantity of a drug.

If you think you need an exception, contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision.

Remember, you can check to see if your drug is on our drug list (formulary) by using the Price-a-drug tool above.

If your medication is not included in the formulary, you should contact us to ask if your medication is covered by your benefit. If you learn that ConnectiCare does not cover your drug, you have two options:

  1. You can ask member services for a list of similar drugs that we cover. Then show the list to your doctor and ask for a prescription for a similar drug that we cover.
  2. Or, you can ask us to make a prescription drug coverage determination (solicitud de determinacion de cobertura de medicamentos de receta de Medicare).
Medicare couple

ADDITional resources

Medicare Forms and Documents

Find more helpful information and documents for your Medicare coverage. 

additional resources

Additional Pharmacy Information

Find additional resources for your prescription coverage, including information on drug coverage determinations. 

We're Here for You

If not currently enrolled call 877-224-8221 (TTY: 711)

From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Friday.

Medicare members call 800-224-2273 (TTY: 711)

From Oct. 1 to March 31, you can call us from 8 a.m. to 8 p.m., seven days a week. From April 1 to Sept. 30, you can call us from 8 a.m. to 8 p.m., Monday through Saturday

Smiling senior man on cell phone at home

Last update 10/01/2024

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