Covered Medication List

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Information Last Updated: 10/1/2021

Pharmacy and Formulary Specifics

The formulary is a comprehensive list of Part D prescription drugs that are covered. Part D prescription drugs are available through MedImpact Healthcare Systems large network of pharmacies.

The formulary represents the prescription therapies believed to be necessary in a quality treatment programs and was designed by Brand New Day in consultation with a team of healthcare providers.

Prescribed medications are covered by the Plan as long as the drug is medically necessary and all plan rules are followed. Refer to your Evidence of Coverage (EOC) for additional information on Part D Prescription Drug coverage or call Brand New Day Pharmacy Services.

2022 Formulary 2021 Formulary

Plan Year 2022

Information Last Updated: 11/8/2021 2:27:17 PM

Plan	Covered Medication List	Notice of Formulary Changes	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Bridges Care Plan (HMO C-SNP) 28	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Bridges Choice Plan (HMO C-SNP) 29	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Care Plan I (HMO) 25	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Care Plan II (HMO) 37	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Care Plan III (HMO) 46	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Choice Plan (HMO C-SNP) 33	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Dual Access Plan (HMO D-SNP) 24	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Care Plan (HMO C-SNP) 47	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Care Plan (HMO C-SNP) 39-1	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Care Plan (HMO C-SNP) 39-2	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Choice Plan (HMO C-SNP) 40-1	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Choice Plan (HMO C-SNP) 40-2	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Harmony Care Plan (HMO C-SNP) 32	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Harmony Choice Plan (HMO C-SNP) 20	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Part B Savings Plan (HMO) 49	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Care I Plan (HMO I-SNP) 42	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Care II Plan (HMO I-SNP) 43	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Choice I Plan (HMO I-SNP) 44	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Choice II Plan (HMO I-SNP) 45	English Spanish Chinese	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
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Plan Year 2021

Information Last Updated: 10/28/2021 4:19:05 PM

Plan	Covered Medication List	Notice of Formulary Changes	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Care I Plan (HMO) 25	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Bridges Care Plan (HMO CSNP) 28	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Harmony Care Plan (HMO CSNP) 32	English Spanish	English Spanish	Formulary Lookup	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Care II Plan (HMO) 37	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Care Plan (HMO CSNP) 39-1	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Care Plan (HMO CSNP) 39-2	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Harmony Choice Plan (HMO CSNP) 20	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Dual Access Plan (HMO DSNP) 24	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Bridges Choice Plan (HMO CSNP) 29	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Classic Choice Plan (HMO) 33	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Choice Plan (HMO CSNP) 40-1	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Embrace Choice Plan (HMO CSNP) 40-2	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Care I Plan (HMO ISNP) 42	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Care II Plan (HMO ISNP) 43	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Choice I Plan (HMO ISNP) 44	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria
Brand New Day Select Choice II Plan (HMO ISNP) 45	English Spanish	English Spanish	Formulary Lookup Tool	Pre-Authorization Criteria	Step Therapy Criteria

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Changes to Our Formulary

Brand New Day may add or remove drugs from our formulary throughout the year. If we remove a drug from our formulary, add prior authorization for a drug, add quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must alert members taking that drug about those changes. If we’re removing a drug from our formulary, we’ll either notify affected members 60 days prior to making that change, or notify them when they request a refill of that drug (at which time the member will also receive a 60-day supply of that drug). If the Food and Drug Administration deems a drug on our formulary to be unsafe, or the drug’s manufacturer removes the drug from the market, we’ll immediately remove the drug from our formulary and provide notice to members taking that drug.

Finding Drugs in the Formulary

To find your prescription drug within the formulary, search by your Plan & Drug name above.

If Your Drug Isn't Listed

Contact our Pharmacy Services Department at 1-866-255-4795 or TTY 711 to discuss options. Or ask your doctor if there's an acceptable alternate medication covered under our formulary.