Comprehensive Formulary 2019  |  Formulary Link

Comprehensive Formulary 2020 |  Abridged Formulary 2020 | Formulary Link for 2020

  • Instructions on how to Find a Drug on the Formulary (click here)


Can the Formulary (drug list) change?

Generally, if you are taking a drug on formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 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.

If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

In the event that Passport Advantage has CMS-approved non-maintenance changes to the formulary throughout the plan year (i.e. remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug), we will update the online formulary link below. You will also be notified in writing if you are affected by the changes via errata sheets.

Please note, Passport Advantage will maintain and update our online formulary on a monthly basis.

Please note, in 2020, click here for a list of covered Diabetic Supplies and Pen Needles for Passport Advantage (HMO SNP).

As a member of Passport Advantage you are eligible to receive a monthly allowance of $40.00 in select Over-the-Counter (OTC) products up to the allowable benefit amount.

OTC medications are trusted as a first line of defense in treating minor ailments, help reduce doctor visits and save you money. Passport Advantage is committed to providing this program to you as a benefit to help you live a healthy lifestyle and improve the quality of your life.

The following categories are available with your program: (click here for the 2019 Over-the-Counter (OTC) Order Form and click here for the 2020 Over-the-Counter (OTC) Order Form)

  • Pain relief
  • Digestion/Laxatives/Antacids
  • Cough/Cold/Allergy
  • Anti-Hemorrhoidals
  • Anti-Fungals
  • First Aid
  • Dental
  • Ear & Eye Care

For the Order Link, click here.

For FAQ, click here | For the 2020 FAQ, click here










Last Modified: November 18, 2019