The formulary is the list of drugs covered by Community Care. It is also called the "Drug List". The drugs on this list were selected with the help of doctors and pharmacists. The list must meet the requirements of Medicare and/or Medicaid.

The formulary explains what prescription drugs are covered by the plan. It also tells you if there are any rules that limit coverage of a drug. PACE provides prescription drugs and certain over-the-counter medications for all members.

If you have Medicare, your prescription drug coverage is through Medicare Part D. If you have Medicaid only, your prescription drug coverage is through Wisconsin Medicaid. All PACE members have the same prescription drug coverage and benefits.

PACE FORMULARY

Coverage Limits
Some covered drugs have limits or conditions for coverage.  The following documents explain the limits and conditions:

• Formulary Prior Authorization Criteria - 2023
  Partnership must approve these drugs before you fill your prescriptions. If you don’t get approval, we may not cover the drug.
• Formulary Step Therapy Criteria - 2023
  We require you to first try certain drugs to treat your medical condition before we will cover another drug for your condition.

Part D Formulary Transition Policy

 
Material ID: H5212_Form_11.2015 CMS Approved: 12/8/2015