Drug List | New Hampshire Medicare Advantage

	WellSense Added Value HMO	WellSense Choice HMO	WellSense Signature HMO
List of Covered Drugs (Formulary)	Look-up covered drugs and pricing Look-up covered drugs and pricing (LIS) Download a printable copy (updated 8/31/23)	Look-up covered drugs and pricing Look up covered drugs and pricing (LIS) Download a printable copy (updated 8/31/23)	Look-up covered drugs and pricing Look up covered drugs and pricing (LIS) Download a printable copy (updated 8/31/23)
Prior Authorization drug list	Prior Authorization drug list	Prior Authorization drug list	Prior Authorization drug list
Step Therapy drug list	Step Therapy drug list	Step Therapy drug list	Step Therapy drug list

	WellSense Added Value HMO	WellSense Choice HMO	WellSense Signature HMO	WellSense Premium Savings HMO
List of Covered Drugs (Formulary)	Look-up covered drugs and pricing Look-up covered drugs and pricing (LIS) Download a printable copy (updated 10/1/23)	Look-up covered drugs and pricing Look-up covered drugs and pricing (LIS) Download a printable copy (updated 10/1/23)	Look-up covered drugs and pricing Look-up covered drugs and pricing (LIS) Download a printable copy (updated 10/1/23)	Look-up covered drugs and pricing Look-up covered drugs and pricing (LIS) Download a printable copy (updated 10/1/23)
Prior Authorization drug list	Coming soon	Coming soon	Coming soon	Coming soon
Step Therapy drug list	Coming soon	Coming soon	Coming soon	Coming soon

WellSense 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.

Get certain prescriptions by mail

You can have medications that you take on a regular basis (called maintenance drugs) sent to your home, so you don’t have to go to the pharmacy every time you need a refill. In some cases, you can get a 90-day supply of medication with each refill. Find out how to get your prescriptions delivered to you.

Some drugs may have restrictions or require approval before you can get them

There may be restrictions on certain drugs in our drug list. These drugs have special rules that must be followed before you can get them. For example, your doctor may need to prove that a certain drug is necessary for your health before a drug will be covered.

Drugs will have codes listed next to them that help explain the restriction. Look up the meanings of those codes. To request approval for a drug that is not covered or restricted, you can submit a request.

Limitations and restrictions may apply. Benefits, formulary, pharmacy network and provider network may change on January 1 of each year. You will receive notice when necessary. For more information, contact the plan.

New Hampshire Medicare Advantage Drug List

Get certain prescriptions by mail

Some drugs may have restrictions or require approval before you can get them