A formulary is a list of covered drugs selected by WellFirst Health — provided by SSM Health Plan — as part of the WellFirst Health Medicare Advantage plans. The list was created 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.
We will cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a WellFirst Health network pharmacy, and other plan rules are followed. For more detailed information about your formulary and how to fill your prescriptions, review your Evidence of Coverage.
We use a closed formulary. If a drug is not listed on the drug formulary, the product is not covered under your pharmacy benefit. If you decide to fill a prescription for a product not on the formulary, you are responsible for 100 percent of the cost of the drug. The cost is also not counted toward deductibles or out-of-pocket maximums.
If you have a question about covered drugs or would like a formulary mailed to you, call our Customer Care Center at 1-877-301-3326 (TTY: 711).