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2017 Senior Care Options Formulary

A formulary is a list of drugs covered by a health plan. Click the links below to see a complete list of drugs covered by your Senior Care Options plan.

List of Covered Drugs

Formulary: List of covered drugs (pdf)Formulary: List of MassHealth covered drugs (pdf)
  • Over-the-Counter Drug List

    Commonwealth Care Alliance covers certain over-the-counter drugs under your MassHealth Standard benefit. We will provide these drugs at no cost to you. You must have a prescription written by your doctor to have the drugs covered by our plan.

    This document provides a list of over-the-counter drugs:

      2017 Formulary for MassHealth-Only Over-the-Counter Drugs (pdf)

  • Prior Authorization Criteria

    For some drugs, you or your provider needs to get approval from Commonwealth Care Alliance before we will agree to cover the drug for you. Sometimes the requirement for getting approval in advance helps guide appropriate use of certain drugs. If you do not get this approval, your drug might not be covered by the plan.

    These documents provide a list of drugs that require prior authorization:

  • Step Therapy Criteria

    Step therapy encourages you to try less costly but just as effective drugs before Commonwealth Care Alliance covers another drug. For example, if Drug A and Drug B treat the same medical condition, the plan may require you to try Drug A first. If Drug A does not work for you, the plan will then cover Drug B.

    This document provides a list of drugs that require step therapy:


     

Changes to the formulary:

We may add or remove drugs from our formulary during the year. If we remove a drug or make a change regarding a drug you use, we will notify you at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration (FDA) determines that a drug on our formulary is unsafe, or if the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary.

 

What if my drug is not on the formulary?

If your drug is not included in this formulary, you should first contact Member Services and confirm that your drug is not covered. If you learn that Commonwealth Care Alliance does not cover your drug, you have two options:
 

You can ask Member Services for a list of similar drugs that are covered. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that we cover.

You can ask us to make an exception and cover your drug. Click here for information about how to request an exception.



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