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Formularies

A formulary is a list of covered drugs selected by Simply Healthcare 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. Simply Healthcare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Simply Healthcare network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.

Simply Healthcare covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Generally if a drug is on our formulary at the beginning of the year, we will not discontinue or reduce coverage of the drug during 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.

To find out more information on covered drugs by Simply Healthcare, click on the links below.

Formulary List of Covered Drugs

 
2018
Miami-Dade Formularies
Simply More (HMO),  Simply Complete (HMO SNP), Simply Level (HMO SNP),
Simply Care (HMO SNP), Simply Comfort (HMO SNP) - Formulary
 
Broward Formularies
Simply More (HMO),  Simply Complete (HMO SNP), Simply Level (HMO SNP), Simply Advantage (HMO SNP),
Simply Care (HMO SNP), Simply Comfort (HMO SNP) - Formulary
 
Palm Beach Formularies
Simply More (HMO),  Simply Complete (HMO SNP), Simply Level (HMO SNP), Simply Advantage (HMO SNP) - Formulary
 
Orange, Osceola, Seminole Formularies
Simply More (HMO), Simply Complete (HMO SNP), Simply Level (HMO SNP), Simply Advantage (HMO SNP) - Formulary
 
Hernando, Hillsborugh, Pasco, Pinellas Formularies
Simply More (HMO), Simply Complete (HMO SNP), Simply Level (HMO SNP), Simply Advantage (HMO SNP) - Formulary
 
Simply More (HMO), Simply Complete (HMO SNP), Simply Level (HMO SNP) - Formulary
 

Transition Policy 


What are Medicare Part B Covered Drugs?


What are Tiers?


Utilization and Medical Management


Step Therapy (ST)


Quantity Limit (QL)


Prior Authorization (PA)


Exceptions


 

Last Updated: 
August 8, 2018