Prescription Drug List – Check our Formulary
If you sign up for our Medicare Advantage Plan with Pharmacy, Medicare Advantage Extra Plan, Medicare Advantage Premium Plan, or the Medicare Advantage Special Needs Plan you will receive coverage for the prescription drugs on our Formulary list and not pay a deductible. The Comprehensive Formulary provides you with a list of drugs covered and their cost sharing tier and any additional requirements or limitations.
Prescription Drug Search
To search for a specific drug, simply open the Formulary Drug List PDF below, click on the Search Function tool bar at the top represented by the binocular icon 
, type the name of the drug you wish to search for in the box that appears on the top right hand side of the page and click Search.
Click Here - Comprehensive Formulary.
Addendums to this directory.
2010 Prior Authorization Criteria
2010 Step Therapy Criteria
2010 Quantity Limits
Requesting exceptions to the Formulary Drug List and coverage policies/procedures.
If your drug is not listed in the formulary, you should first contact Customer Service and ask if your drug is covered. If you learn that Community HealthFirst does not cover your drug, you may request an exception be made for coverage of that drug. You may also ask us to waive coverage restrictions or limits on a drug.
- You can ask us to cover your drug even if it is not on our formulary.
- You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, Community HealthFirst limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover more.
Generally, Community HealthFirst will only approve your request for an exception if the alternative drugs included on the plan’s formulary, or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects.
We realize that situation may arise where you may need to access drugs that are not on the formulary or cases in which you need a refill sooner than expected. We call this a Plan Transition Process and have taken into account these special circumstances.
Plan Transition Process.
Questions about Prescription Drug coverage?
If you have any questions about our Formulary Drug List, tiering, copay levels or policies, please call Customer Service, 8 a.m. to 8 p.m., 7 days a week. Current Members should call 1-800-942-0247, Prospective Members should call 1-800-944-1247 and all TTY/TDD hearing impaired users should call 1-866-816-2479. Or you can send questions to Community HealthFirst, PO Box 960, Seattle, WA 98111-0960
Quality Assurance Policies and Procedures
It is Community HealthFirst’s policy to emphasize the quality of your pharmaceutical care. Our goal is to provide you with the most effective and affordable medications available to improve your health.
We use the best research and evidence available in developing our formulary to ensure that you have access to cost-effective medications.
We offer a medication therapy management program to qualified members. This program is intended to optimize the drug therapy for our members who have the following chronic conditions: asthma, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), depression, diabetes, high blood cholesterol, high blood pressure and osteoporosis. This program is intended to optimize the drug therapy for our members who have the following chronic conditions: Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Hypertension, Asthma, and high blood cholesterol. These programs may have limited eligibility criteria. If you have questions about the medication therapy management program, please call Customer Service, 8 a.m. to 8 p.m., 7 days a week. Current Members should call 1-800-942-0247, Prospective Members should call 1-800-944-1247 and all TTY/TDD hearing impaired users should call 1-866-816-2479.