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                        Medicare-Approved 2017 Closed Formulary: 00017449
  5 Tier Closed Formulary


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

The following Incentive Formulary applies to members of an employer/retiree, union, or trust fund health plan, please click here to access the 2017 Incentive formulary (00017450)

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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Formulary Id: 00017449
Formulary Effective Date: 11/01/2017
CMS Marketing Materials Id:
Y0037_16_0862 Approved

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