Formulary Information

Do you have a Tribute^® HMO SNP Medicare Advantage Prescription Drug Plan?

A formulary is a list of covered drugs selected by Tribute 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. Tribute will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed.

• You can search the formulary
• You can download and print the comprehensive formulary (see below)
• You can download and print an update (addendum) to the comprehensive formulary (see below)

We may periodically add, remove or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary changes that limit our members' ability to fill their prescriptions, we will notify the affected enrollees before the change is made. The Comprehensive and Abridged formularies were last updated in August 2011. Changes to our formulary are updated via a monthly supplemental addendum.

Need a hard copy of the Tribute list of covered drugs?

• Tribute SNP HMO Abridged Formulary (PDF)
• Tribute SNP HMO Comprehensive Formulary (PDF)

Monthly Formulary Addendum

Changes to our formulary are updated via a monthly supplemental addendum. For complete formulary information, search the formulary.

Formulary Addendum - Updated 2/2012

• Tribute SNP HMO Formulary Addendum (PDF)

Upcoming Formulary Changes

If we make formulary changes such as:

• removing drugs from the formulary,
• adding a prior authorization for a drug,
• adding quantity limits and/or step therapy restrictions on a drug,
• and/or moving a drug to a higher cost-sharing tier

We will notify you of the change at least 60 days before the date that the change becomes effective. However, if the Food and Drug Administration deems a drug on our formulary to be unsafe, or if the drug's manufacturer removes the drug from the market, we will immediately remove the drug from the formulary.

Formulary Changes

• Formulary Changes – Coming Soon

Read about the Tribute Transition Policy