Welcome to the Highmark
Wholecare Medicare Assured Diamond/ Ruby Formulary.
You can search the formulary (list of covered drugs)
in several ways.
- Drug brand or generic name: type the drug name with correct spelling in the search
bar show formulary status of the drug (Tier 1-5 or non-formulary)
- National Drug Code (NDC): type the 11 digit NDC number (without dashes or spaces) into the search
bar to show formulary status of the drug
- Therapeutic class:
click on the desired drug class and subclass to show formulary options
Once you find the searched drug, click on the drug name for
more information.
- If the drug has any limitations such as prior
authorization, step therapy, quantity limits, etc., click “more info” by the
icon for a description of the limitation.
- If the drug is non-formulary (stop sign symbol),
there may be an option to click the “see therapeutic alternatives” link to show
similar options available on our formulary.
For drugs that are non-formulary or have a coverage
limitation, you or your prescriber have the right to request a coverage
determination or exception.
- You may submit a request via CoverMyMeds.com or by faxing or mailing the Medicare Request for Drug Coverage Form
- Click here for more information on how to submit a request
Rather than search for drugs individually, you may
also view and download our
2023 Medicare PDF Formulary
Maintenance updates to the formulary are
listed here: 2023 Formulary Updates
Important Message About What You Pay for Insulin-You won't pay more than $0 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it's on.
Import Message About What You Pay for Vaccines- Our plan covers most Part D vaccines at no cost to you. Call Member Services for more information.
To speak to a Pharmacy Services Representative, please call 1-800-685-5209.