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Kaiser Permanente 2022 Comprehensive Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN This formulary was updated on 12/01/22. For more recent information or other questions, please contact the number for your Kaiser Permanente Region listed below, seven days a week, 8 a.m. to 8 p.m., or visit kp.org/seniorrx. Kaiser Permanente Regions CALIFORNIA REGIONS HAWAII REGION Kaiser Permanente Senior Advantage (HMO) Kaiser Permanente Senior Advantage (HMO) Member Service Contact Center Member Services 1-800-443-0815 TTY 711 1-800-805-2739 TTY 711 COLORADO REGION MID-ATLANTIC STATES REGION Kaiser Permanente Senior Advantage (HMO) (District of Columbia, Maryland, and Virginia) Member Services Kaiser Permanente Medicare Advantage (HMO) 1-800-476-2167 TTY 711 Member Services GEORGIA REGION 1-888-777-5536 TTY 711 Kaiser Permanente Senior Advantage (HMO) NORTHWEST REGION and Senior Advantage Medicare Medicaid Kaiser Permanente Senior Advantage (HMO) Plan (HMO D-SNP) Member Services Member Services 1-877-221-8221 TTY 711 1-800-232-4404 TTY 711 Y0043_N00031421_Final12_C HPMS Approved Formulary File Submission 00022483, Version 19 Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to “we,” “us,” or “our,” it means Kaiser Permanente. When it refers to “plan” or “our plan,” it means Kaiser Permanente Senior Advantage or Kaiser Permanente Medicare Advantage, depending upon the region in which you are enrolled. This document includes a list of the drugs (formulary) for our plan which is current as of December 1, 2022. For an updated formulary, please visit our website at kp.org/seniorrx or call us. Contact information for your Kaiser Permanente Region, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. The formulary and pharmacy network may change at any time. You will receive notice when necessary. What is the Kaiser Permanente adding the new generic drug, we may decide Formulary? to keep the brand name drug on our Drug List, but immediately move it to a different A formulary is a list of covered drugs selected cost-sharing tier or add new restrictions. If by Kaiser Permanente in consultation with a you are currently taking that brand name team of health care providers, which drug, we may not tell you in advance before represents the prescription therapies believed we make that change, but we will later to be a necessary part of a quality treatment provide you with information about the program. Our plan will generally cover the specific change(s) we have made. drugs listed in our formulary as long as the drug is medically necessary, the prescription • If we make such a change, you or your is filled at a Kaiser Permanente network prescriber can ask us to make an pharmacy, and other plan rules are followed. exception and continue to cover the For more information on how to fill your brand name drug for you. The notice prescriptions, please review your Evidence we provide you will also include of Coverage. information on how to request an exception, and you can find Contact information for your Kaiser information in the section below titled Permanente Region, along with the date we “How do I request an exception to the last updated the formulary, appears on the Kaiser Permanente Formulary?” front and back cover pages. Drugs removed from the market Can the formulary (drug list) If the Food and Drug Administration (FDA) change? deems a drug on our formulary to be unsafe Most changes in drug coverage happen on or the drug’s manufacturer removes the drug January 1, but Kaiser Permanente may add from the market, we will immediately remove or remove drugs on the Drug List during the the drug from our formulary and provide year, move them to different cost-sharing notice to members who take the drug. tiers, or add new restrictions. We must follow Other changes Medicare rules in making these changes. We may make other changes that affect Changes that can affect you this year: members currently taking a drug. For instance, we may add a generic drug that is In the below cases, you will be affected by not new to market to replace a brand name coverage changes during the year: drug currently on the formulary or add new restrictions to the brand name drug or move it New generic drugs to a different cost-sharing tier or both. Or we may make changes based on new clinical We may immediately remove a brand name guidelines. If we remove drugs from our drug on our Drug List if we are replacing it formulary, or add prior authorization, or move with a new generic drug that will appear on a drug to a higher cost-sharing tier, we must the same or lower cost sharing tier and with notify affected members of the change at the same or fewer restrictions. Also, when least 30 days before the change becomes Kaiser Permanente 2022 Comprehensive Formulary • 1 effective, or at the time the member requests How do I use the formulary? a refill of the drug, at which time the member will receive a 30-day supply of the drug. There are two ways to find your drug within the formulary: • If we make other changes, you or your prescriber can ask us to make an Medical condition exception and continue to cover the brand name drug for you. The notice The formulary begins on page 6. The drugs in we provide you will include information this formulary are grouped into categories on how to request an exception. You depending on the type of medical conditions can find information in the section that they are used to treat. For example, below entitled “How do I request an drugs used to treat a heart condition are listed exception to the Kaiser Permanente under the category, “Cardiovascular Drugs”. Formulary?” If you know what your drug is used for, look for the category name in the list that begins Changes that will not affect you if you are on page 8. Then look under the category currently taking the drug. name for your drug. Generally, if you are taking a drug on our 2022 formulary that was covered at the Alphabetical listing beginning of the year, we will not discontinue or reduce coverage of the drug during the If you are not sure what category to look 2022 coverage year except as described under, you should look for your drug in the above. This means these drugs will remain index that begins on page 70. The index available at the same cost-sharing and with provides an alphabetical list of all the drugs no new restrictions for those members taking included in this document. Preferred generic them for the remainder of the coverage year. and generic drugs, preferred brand-name and You will not get direct notice this year about nonpreferred brand-name drugs, specialty-tier changes that do not affect you. However, on drugs, and injectable vaccines are listed in January 1 of the next year, such changes would affect you, and it is important to check the index. Look in the index and find your the Drug List for the new benefit year for any drug. Next to your drug, you will see the page changes to drugs. number where you can find coverage information. Turn to the page listed in the The enclosed formulary is current as of index and find the name of your drug in the December 1, 2022. To get updated first column of the list. information about the drugs covered by our plan, please call us. Contact information for What are generic drugs? your Kaiser Permanente Region appears on the front and back cover pages. Our plan covers both brand-name drugs and In the event of a midyear generic drugs. A generic drug is approved by non-maintenance formulary change, the FDA as having the same active ingredient we will provide details in the Medicare as the brand-name drug. Generally, generic Part D Explanation of Benefits that drugs cost less than brand-name drugs. Cost we send you or Provision of Notice sharing for preferred generic drugs may be posted at kp.org/seniorrx. different than for generic drugs. Please see 2 • Kaiser Permanente 2022 Comprehensive Formulary
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