Formulary

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Plan Formularies

A formulary is a list of medications that are covered by your plan.

Please see the below list to review your plan formulary. Or you can call us at the number listed on your member identification card.

2014 Formulary




Formulary Change Notice - English

Premier Plus

Springfield/Joplin 
Arkansas
Kansas City Metro
Topeka/Wichita
Secure Plus

Springfield/Joplin
Arkansas
Kansas City Metro
Topeka/Wichita
Oklahoma


Formulary Change Notice - Spanish

Premier Plus
Arkansas Kansas City Metro
Secure Plus
Oklahoma



Online Formulary Search

Online Formulary Search
Obtain pricing and coverage information for any medications available through your plan.


Printable Formulary - English


Advantra Advantage (HMO)
Advantra Premier Plus (PPO)
Advantra Total Care (HMO)
Coventry Advantage (HMO) - Missouri
Coventry Premier Plus (PPO)

Coventry Advantage Plus (HMO-POS)
Advantra Freedom (PPO) (H5509-001/H5509-012)
Coventry Medicare Advantage Total Care (HMO)
Coventry Medicare Advantage (PPO)
Coventry Total Care (PPO)

Coventry Select (HMO SNP)

Advantra Freedom Plus (PPO)

Advantra Freedom (PPO) (H5509-010/H5509-011/H5509-016)
Coventry Freedom (PPO) - Oklahoma
Coventry Advantage (HMO) - Oklahoma



Printable Formulary - Spanish




Advantra Advantage (HMO)
Advantra Total Care (HMO)
Advantra Freedom (PPO) (H5509-010, H5509-011/H5509-016)
Coventry Freedom (PPO) - Oklahoma
Coventry Advantage (HMO) - Oklahoma


Additional Information

Grievances & Appeals
Grievance & appeal information for members.

Medicare Part D Prescription Drug Benefits

Click here to find more information about Coventry's Part D benefits.

find a plan

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Page Last Updated: 03/28/2014
CMS Approved Date: Approved 02/08/2013
CMS Document ID: Y0022_PDPCCP_2013_4006_1202b

© Copyright 2008-2014 Coventry Health Care

Coventry Health Care is a Coordinated Care plan with a Medicare contract. First Health Part D is a Medicare-approved Part D sponsor. Enrollment in our plans depends on contract renewal.