Formularies (Drug Lists)
A formulary, or drug list, is a list of drugs covered by your Medicare Part D plan benefit. A drug list may also be referred to as a covered medications list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.
To view a plan's complete formulary or drug list (PDF), go to View plans and pricing, enter your ZIP code and select one of the AARP® MedicareRx Plans insured through UnitedHealthcare. The drug list may change during the plan year. Additions or deletions made to drug lists will be posted along with the effective date in the 60-day formulary change notice section below. For complete formulary information, look up prescription drugs.
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2014 Prior authorization criteria
The plan requires you or your doctor to get prior authorization for certain drugs. This means the plan needs more information from your doctor to make sure the drug is being used correctly for a medical condition covered by Medicare. If you don't get approval, the plan may not cover the drug. To view your plan's prior authorization criteria to determine if your drugs qualify for coverage, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. You can find the 2014 Prior Authorization Criteria (PDF) in the Helpful Resources section of the Plan Details page.
2014 Step therapy criteria
There are effective, lower-cost drugs that treat the same medical condition as this drug. You may be required to try one or more of these other drugs before the plan will cover your drug. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
To view your plan's step therapy criteria to determine if your drugs qualify for coverage, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. You can find the 2014 Step Therapy Criteria (PDF) in the Helpful Resources section of the Plan Details page.
60-day formulary change notice
Notice of Formulary Changes will be posted 60 days prior to the removal or change in the preferred or tiered cost-sharing status of a Medicare Part D drug. The posting will include:
- The name of the affected covered Medicare Part D drug.
- Information on whether the drug is being removed from the drug list or changing its preferred or tiered cost-sharing status.
- The reason why the drug is being removed from the drug list or changing its preferred or tiered cost-sharing status.
- Alternative drugs in the same therapeutic category, class or cost-sharing tier and the expected cost-sharing for that drug.
- Information for members on how to obtain an updated coverage determination or an exception to a coverage determination.
Note: You will also be notified in your Explanation of Benefits (EOB) about a drug list change 60 days before it takes effect.
If you're a continuing member in the plan, you'll receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year’s formulary or its cost-sharing or coverage is limited in the upcoming year. If your drug has been removed from the formulary or has a new requirement and limit that you must follow, the plan will send you a separate communication to notify you.
Formulary deletions update
Formulary additions update
Prescription Drug Transition Process
View the Transition Process - AARP MedicareRx Plans.
Learn more about coverage determinations and appeals, drug conditions and limitations and quality assurance policies.