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Formulary (list of covered drugs)
A formulary is a list of drugs, or prescriptions, that a plan covers. First Choice VIP Care (HMO-SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. For more information on how to fill your prescriptions, see the First Choice VIP Care Evidence of Coverage (PDF)
The formulary has been reviewed and approved by the Centers for Medicare Medicaid Services (CMS), the agency that administers Medicare. Formulary medications are approved by the U.S. Food and Drug Administration (FDA), and have been chosen for their reported medical effectiveness and value. The formulary is updated at times throughout the year, and the list of drugs may change. CMS defines brand and generic drugs based on what kind of application the drug manufacturer filed with the FDA.
- Drugs filed with a New Drug Application (NDA) are considered brand for purposes of catastrophic and LIS cost share.
- Drugs filed with an Abbreviated New Drug Application (ANDA) are considered generics.
- This will not always match up to the brand/generic formulary tier assignments defined by Amerihealth Caritas
First Choice VIP Care covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient as brand name drugs. Generic drugs usually cost less than brand name drugs and are rated by the FDA to be as safe and effective as brand name drugs.
Want regular information about your pharmacy benefits? Look out for your monthly explanation of pharmacy benefits in the mail.
Prescription drug frequently asked questions (FAQs)
First Choice VIP Care 2023 drug formulary
- Searchable online formulary
- Printable comprehensive formulary PDF May 24, 2023
- Printable Spanish formulary PDF February 1, 2023
- Machine-readable list of covered drugs (is in accordance with CMS standard) JSON May 18, 2023
- Prior authorization criteria PDF June 1, 2023
- Step therapy criteria PDF June 1, 2023
- Prescription drug frequently asked questions (FAQs)
Answers to commonly asked questions, like "What if my drug is not on the formulary?" and "What are over-the-counter (OTC) drugs?"
- Find a pharmacy
- Formulary updates PDF June 1, 2023
View and/or print the formulary updates
- Preferred diabetic supplies PDF
Please find updates to Preferred Diabetic Supplies effective May 10, 2023. For questions, please contact Member Services at 1-888-996-0499 (TTY 711)., 8 a.m. – 8 p.m., Monday through Friday, from April 1 to September 30. From October 1 to March 31, 8 a.m. – 8 p.m., seven days a week.