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Covered Medication List

Information Last Updated: 10/13/2022

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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.

Plan Year 2023

Information Last Updated: 11/17/2022 1:45:24 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
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Bridges Choice Plan (HMO C-SNP) 29 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Classic Care I Plan (HMO) 50-1 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Classic Care I Plan (HMO) 50-2 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Classic Care II Plan (HMO) 51-1 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Classic Care II Plan (HMO) 51-2 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Pre-Authorization Criteria Coming soon!
Brand New Day Classic Care Plan III (HMO) 46 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Dual Access Plan (HMO D-SNP) 24 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Embrace Care Plan (HMO C-SNP) 47 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Embrace Care Plan (HMO C-SNP) 39-1 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Embrace Care Plan (HMO C-SNP) 39-2 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Embrace Choice Plan (HMO C-SNP) 40-1 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Embrace Choice Plan (HMO C-SNP) 40-2 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Part B Savings Plan (HMO) 49 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Select Care I Plan (HMO I-SNP) 42 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Select Care II Plan (HMO I-SNP) 43 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Select Choice I Plan (HMO I-SNP) 44 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Pre-Authorization Criteria Step Therapy Criteria
Brand New Day Select Choice II Plan (HMO I-SNP) 45 English
Spanish
Chinese
Korean
Vietnamese
Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
Brand New Day Valor Care Plan (HMO) 48 - Part B Only No Part D Coverage Coming soon! Formulary Lookup Tool Coming soon! Coming soon!
MEDICATION THERAPY MANAGEMENT PROGRAM
Medication Therapy Management Program

PREFERRED DIABETIC TESTING SUPPLIES
Preferred Diabetic Testing Supplies

Plan Year 2022

Information Last Updated: 12/1/2022 7:00:54 AM
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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
Brand New Day Valor Care Plan (HMO) 48 - Part B Only No Part D Coverage English

Spanish
Formulary Lookup Tool Pre-Authorization Criteria Step Therapy Criteria
MEDICATION THERAPY MANAGEMENT PROGRAM
Medication Therapy Management Program

Medication Therapy Management Program

Medication Therapy Management Program

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

For plan year 2022

Contact MedImpact.

MedImpact Direct Contact Information

Call: 1-855-873-8739, TTY: 711
Fax: 1-888-873-1773
Hours of Operation: Monday – Friday 5 a.m. – 5 p.m. and Saturdays 6 a.m. – 2 p.m.
Email: customerservice@medimpactdirect.com
Website: www.medimpactdirect.com/MailOrderRefills

For plan year 2023

Contact Express Scripts at 1-800-935-6103 or TTY 1-800-899-2114 to discuss options. Or ask your doctor if there's an acceptable alternate medication covered under our formulary.

Express Scripts Contact Information
Call 1-800-935-6103 or TTY 1-800-899-2114
Hours of Operation 24 hours a day, 7 days a week
Mail Express Scripts
Attn: Medicare Reviews
P.O. Box 66571
St. Louis, Mo
63166-6571
Fax 1-877-251-5896

If you feel you were already charged incorrectly at the pharmacy, you can file an appeal to request reconsideration. If you would like to file an appeal, please call Express Scripts at 1-800-935-6103, available 24 hours a day, 7 days a week.

Related information

Prescription Drug Transition Policy

Part D Prior Authorizations, Coverage Determinations, and Exceptions

Extra Help to Pay for Prescription Drugs

The Buzz on Statins

If we say no to your appeal, you decide if you want to continue with the appeals process and make another appeal.

If we say no to your appeal, we will send a written notice telling you why we said no. You then choose whether to accept this decision or continue by making another appeal. The written notice tells you how to make another appeal. If you decide to make another appeal, it means your appeal is going on to Level 2 of the appeals process. If you decide to go on to a Level 2 Appeal, the Independent Review Organization (C2C Innovative Solutions, Inc.) reviews the decision we made when we said no to your first appeal. C2C decides whether the decision we made should be changed.