MVP Health Care 2025 Medicare Part D Formulary (List of Covered Drugs) - Updated 12/2025

Sep 5, 2026

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2025 Medicare Part D Formulary lists covered prescription drugs for MVP Health Care beneficiaries under Medicare Advantage coverage through a former employer. The formulary explains how covered drugs are selected, generally covered when medically necessary, filled at an MVP network pharmacy, and subject to plan rules. It outlines when and how drug coverage can change, including immediate substitutions, removal of withdrawn drugs, and other updates such as tier moves or new restrictions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages122

Reading Time5 h 7 min

AccessFree to download

MVP Health Care Medicare Part D Abridged Formulary

What is a formulary

Can the formulary change

Changes that can affect you this year

How drugs may be substituted or removed

Other changes and member exceptions

MVP Health Care ® 2025 Medicare Part D Formulary (List of Covered Drugs) For Medicare Advantage plan coverage through a former employer. Please Read: This document contains information about the drugs we cover in this plan. This Formulary was updated on December 1, 2025. For more recent information or questions, please contact the MVP Medicare Customer Care Center. Additional Resources to Help: Please contact the MVP Medicare Customer Care Center at 1-800-665-7924 for additional information. TTY users should call 711. Hours are seven days a week, 8 am-8 pm Eastern Time. April 1-September 30, call Monday-Friday, 8 am-8 pm. [Visit](Visit mvphealthcare.com/partdformulary for)[ ](Visit mvphealthcare.com/partdformulary for)[mvphealthcare.com/partdformulary](Visit mvphealthcare.com/partdformulary for)[ for](Visit mvphealthcare.com/partdformulary for) the most up-to-date Formulary listing. Formulary ID 25354, Version 20 Updated 12/2025 Y0051_9982_C Note to existing members: This Formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (Formulary) refers to “we,”“us”, or “our,” it means MVP Health Care (MVP) . When it refers to “plan” or “our plan,” it means Preferred Gold (HMO-POS), or USA Care (PPO) . This document includes a list of the drugs (Formulary) for our plan which is current as of December 1, 2025. For an updated comprehensive Formulary, please contact us. Our contact information, along with the date we last updated the Formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, Formulary, pharmacy network, and/or co-payments/co-insurance may change on January 1, 2026, and from time to time during the year. What is the MVP Health Care Medicare Part D Abridged Formulary? A Formulary is a list of covered drugs selected by MVP Health Care in consultation with a team of health care providers, which represents the prescription therapies believed to bea necessary part of a quality treatment program. MVP will generally cover the drugs listed in our Formulary as long as the drug is medically necessary, the prescription is filled at an MVP network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary (Drug List) Change? Most changes in drug coverage happen on January 1, but MVP may add or remove drugs on the Drug List during the year, move them to different cost‑sharing tiers, or add new restrictions. We must follow the Medicare rules in making these changes. Changes That Can Affect You This Year In the below cases, you will be affected by coverage changes during the year. Immediate Substitutions of certain new versions of brand name drugs and original biological products We may immediately remove a drug from our formulary if we are replacing it with a certain new version of that drug that will appear on the same or lower cost-sharing tier and with the same or fewer restrictions. When we add a new version of a drug to our formulary, we may decide to keep the brand name drug or original biological product on our formulary, but immediately move it to a different cost-sharing tier or add new restrictions. We can make these immediate changes only if we are adding a new generic version of a brand name drug, or adding certain new biosimilar versions of an original biological product, that was already on the formulary (for example, adding an interchangeable biosimilar that can be substituted for an original biological product by a pharmacy without a new prescription) . If you are currently taking the brand name drug or original biological product, we may not tell you in advance before we make an immediate change, but we will later provide you with information about the specific change(s) we have made. If we make such a

FAQs

What happens if a drug is removed or changed on the formulary?

If changes affect coverage, affected members may be notified based on the type of change. Members or prescribers can request an exception to continue coverage for the drug being changed.

Sep 5, 2026

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