CHP Medicare

• Learn More - Attend a Seminar
• Benefits & Coverage
  • Summary of Benefits
  • Your Premium
  • Cost Sharing
  • Evidence of Coverage
  • Out-of-Network Coverage
  • Conditions & Limitations
  • Potential for Contract Termination
  • Disenrollment Rights & Responsibilities
  • Health Club/Fitness Class Membership
• Medicare-Approved Prescription Drug Coverage
  • Extra Help from Medicare
  • Transition Process
  • Formulary
  • Formulary Change Notice
• Physicians
• Enrollment
• Determinations, Grievances & Appeals
• Part D Exceptions

Capital Health Plan Medicare Advantage Formulary

A formulary is a list of covered drugs, which represents the prescription therapies believed to be a necessary part of a quality treatment program. The formulary is selected by Capital Health Plan in consultation with a team of health care providers. You may search for drug(s) by using the Formulary Search Tool below or you may view the entire Capital Health Plan 2008 Formulary (PDF).

Capital Health Plan covers both brand name drugs and generic drugs. Generic drugs have the same active ingredient formulary as brand name drugs. Generic drugs usually cost less than brand name drugs and are rated by the United States Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

The formulary may change during the year. We update the formulary on our website each month. Generally, if you are taking a Part D drug on our 2008 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the Part D drug during the 2008 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a Part D drug from our formulary, will not affect members who currently are taking the drug. That drug will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year.

By law, certain types of drugs or categories of drugs are not covered by Medicare Prescription Drug Plans. Please see the list of these excluded drugs here.

For more information on prescription drug coverage, please review your Evidence of Coverage.

Please use the Formulary Search Tool below to find your prescription drug(s). You also may view the CHP Medicare Advantage Formulary (List of Covered Drugs) (PDF).

To learn more about our grievances, coverage determinations, exceptions, and appeals processes, and the procedure members must follow to file a grievance or request a coverage determination, exception, or appeal, please review our Grievances & Appeals section. You also may click on the Part D Exceptions button to the left to learn how to seek an exception to the CHP Medicare Advantage formulary.