The IBC Drug Formulary

The IBC Drug Formulary is a list of FDA-approved drugs we cover. Our Pharmacy and Therapeutics Committee has carefully chosen these drugs for their medical effectiveness and value.

We may periodically add or remove covered drugs, change coverage limitations on certain drugs, or change how much you pay for a drug.

Find a Drug on the Formulary

Search the IBC Drug Formulary alphabetically by drug name or by drug class. You can also check the formulary for drugs recently added to or removed from the formulary.

See Exceptions and Appeals to learn how to obtain an exception to the plan’s formulary.

2013

Keystone 65 Preferred HMO and Personal Choice 65 PPO Members	Download the Keystone 65 Preferred HMO and Personal Choice 65 PPO Formulary. Y0041_HM_13_2711 Accepted 09/02/2012 Download the Addendum to the Keystone 65 Preferred HMO and Personal Choice 65 PPO Formulary Y0041_HNS_13_5450 CMS Approved 10/26/2012
Keystone 65 Select Members	Download the Keystone 65 Select HMO Formulary. Y0041_H3952_KS_13_2679 Accepted 09/02/2012 Download the Addendum to the Keystone 65 Select HMO Formulary. Y0041_HNS_13_5782 CMS Approved 10/26/2012
Keystone 65 HMO, Personal Choice 65 PPO, and Select Option PDP Group Members	Download the Keystone 65 HMO, Personal Choice 65 PPO, and Select Option PDP Group 3 Tier Formulary. Download the Addendum to the Keystone 65 HMO, Personal Choice 65 PPO, and Select Option PDP Group 3 Tier Formulary. Download the Keystone 65 HMO, Personal Choice 65 PPO, and Select Option PDP Group 4 Tier Formulary. Download the Addendum to the Keystone 65 HMO, Personal Choice 65 PPO, and Select Option PDP Group 4 Tier Formulary.

Formulary Changes
We regularly review the formulary to ensure its continued effectiveness. The formulary may change during the year. We may remove drugs from the formulary, or add prior authorizations, quantity limits, restrictions on a drug, or move a drug to a higher cost-sharing tier.

If a prescription you’re taking is affected by a formulary change, we will notify you, in writing, at least 60 days before the date it takes effect.

If we don’t notify you in advance of the change, you will get a 60-day supply of the drug when you request a refill of the drug.

In case of a market recall, we will not give you 60 days’ notice before removing the drug. Instead, we will remove the drug from our formulary immediately and notify members about the change as soon as possible.

Website last updated: 4/12/2013
Y0041_HM_13_3639c Approved 4/4/2013