List of Drugs (Formulary)
Our list of drugs (formulary) shows the drugs we cover. The list includes:
- Medicare Part D drugs
- Some Medicaid covered prescription and over-the-counter drugs and items
In general, we cover drugs if they are medically necessary. Drugs on the list of drugs are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.
The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves the list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
How do I search for a drug in the List of Drugs?
You can search for a drug by using either the drug search tool or by opening a PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives.
The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the PDF drug list. The drug list is updated monthly.
List of Drugs Change Notice
Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before the following changes are made to the list of drugs.
- Remove a drug from the list
- Change drug requirements
- Move a drug to a higher cost sharing tier
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. To view the changes, open the PDF list below.
If you have questions about our list of drugs, or want the most recent version, contact Member Services. We are here to help.
For a list of drugs covered under your plan or your patient's plan, step therapy and prior authorization criteria, or for information about coverage determination requests, view or download a copy of the documents below.
A comprehensive formulary includes the entire list of drugs covered by MeridianComplete . This formulary is a list of covered drugs selected by MeridianComplete in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. MeridianComplete will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a MeridianComplete network pharmacy, and other plan rules are followed.
For more information on how to fill prescriptions, please review your Member Handbook.
- 2021 List of Covered Drugs (Formulary) (PDF)
- 2021 Prior Authorization Criteria (PDF)
- 2021 Step Therapy Criteria (PDF)
The Formulary Updates document outlines drugs that have been updated, added to, or removed from our current formulary.
Generally, if you are taking a drug on our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 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 drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety.
Cost Sharing Information
MeridianComplete has no premiums, deductibles, or coinsurance. For Generic Drugs covered by Medicare, members will pay $0 for prescriptions. For Brand Drugs covered by Medicare, members will pay $0 for prescriptions. Members will pay nothing for Medicaid-covered prescriptions. If you have any questions or concerns about premiums and/or cost-sharing associated with enrollment in MeridianComplete, call Member Services at 1-855-323-4578 (TTY 711), Monday - Friday from 8 a.m. - 8 p.m.