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                      Medicare-Approved 2021 Performance Formulary: 21062

  5 Tier Performance Formulary

Download the latest comprehensive copy of the Medicare Part-D formulary with prior authorization here.

For detailed instructions on how to use this site, please click here

All drugs returned upon search are covered on the formulary. The formulary status (e.g., tier) and any applicable coverage restrictions (e.g., prior authorization, quantity limit) are denoted by symbols. A “Definition of Symbols” is displayed immediately following the search results.


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Federal Contracting Statement:
Highmark Senior Health Company, Highmark Choice Company and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. HM Health Insurance Company is a PDP plan with a Medicare contract. Enrollment in Highmark Senior Health Company, Highmark Choice Company, Highmark Senior Solutions Company and HM Health Insurance Company depends on contract renewal.


Formulary Id: 21062
Formulary Effective Date: 09/01/2021
CMS Approval Date:
CMS Version:
CMS Marketing Materials Id:

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