Pharmacy services overview

About our drug formulary

The Pharmacy & Therapeutics Committee (P&T) develops the Kaiser Permanente drug formulary, the cornerstone of medication therapy, quality assurance, and cost-containment efforts. The formulary is a list of medications that are usually covered under a member's pharmacy benefit.

Both the Kaiser Permanente and Kaiser Permanente Medicare Part D Drug formularies are searchable. You can download the commercial formulary to your smart phone or access it online through Epocrates. You may also request a hard copy of the formulary from Member Services.

To make formulary recommendations, contact your district medical director or a Kaiser Permanente clinical pharmacist.

The committee regularly reviews new and existing medications in all therapeutic categories and selects the most cost-effective agents in each class based on safety, efficacy, and cost to ensure that the formulary remains responsive to the needs of members and providers. You can review the decisions made at the most recent committee meeting in the quarterly Formulary Decision Highlights.

Formulary tools

Drug formulary search: Search for drugs by name or therapeutic class.

Epocrates downloadable formulary: Check formulary status and prior authorization criteria for medications covered under the pharmacy benefit.

Drug formulary exception request: Request coverage for medications requiring prior authorization and for drugs not included in the formulary. To submit a formulary exception on behalf of a patient, call the Drug Benefit Help Desk at 1-800-729-1174, option 1, or fax to 1-866-439-0050. Patients can also submit a formulary exception request via the online form on the secure member website.

Chronic high-dose opioid therapy Prior authorization form (PDF): Effective 10/1/18, commercial members on chronic opioid therapy >=90 mg MED/day will require prior authorization to ensure their care plan supports safe use of opioids.

Prior authorization for injectable drugs

Kaiser Permanente requires prior authorization of certain injectable medications administered in the office or home infusion setting. These reviews ensure that benefits are adjudicated and that use is in line with Pharmacy & Therapeutics Committee criteria. Please see Injectable Drugs Requiring Prior Authorization for more information on how to obtain prior authorization for these drugs.

Pharmacy & Therapeutics Committee

The Pharmacy & Therapeutics Committee, composed of Kaiser Permanente contracted clinicians from various medical specialties across the state, follows these guiding principles:

• The ultimate responsibility of the committee is to Kaiser Permanente's consumer-elected governance board.
• The committee assumes they will be caring for the same group of patients a decade from now and focuses on the best long term interest of their patients.
• The committee uses an evidence-based decision making process, putting stronger emphasis on clinical data than expert opinion.
• Besides evaluating the efficacy and safety of drug treatments, the committee also makes a value judgment about cost vs. benefit.

The decision to add a medication to the agenda for review by the Pharmacy & Therapeutics Committee is dependent upon several factors, including demand for a medication and the frequency of requests received for an individual drug, as well as the availability of published literature and controlled trials supporting its use.

Requests must include reasoning, suggestions for appropriate restrictions or usage guidelines, and references to relevant literature. The committee support staff will compile the review and assess the request.

Specialty Pharmacy Services

Kaiser Permanente Washington Specialty Pharmacy works closely with its Washington region and Kaiser Permanente visiting members and providers to manage high-cost medications that require close supervision and monitoring for serious chronic conditions. Please see this flyer (PDF) for detailed information about using our specialty pharmacy services to care for your Kaiser Permanente patients.

Specialty Home Infusion Pharmacy Services

Kaiser Permanente Washington Home Infusion Pharmacy is a dedicated team available to members receiving home infusion. This team partners with providers and nurses to make sure members are receiving the right medicine and dose, while monitoring their treatment. Please see Kaiser Permanente Washington Home Infusion Pharmacy for detailed information about using our home infusion pharmacy services to care for your Kaiser Permanente patients.

Self-administered medications

The self-administered drug policy (PDF) includes the criteria used to identify that a medication is self-administered and provides a list of medications that are not covered under the medical benefit.