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Y0055_MPC092566_NSR_C_09262025
Last Updated: 10/1/2025

Presbyterian Medicare Advantage Formularies

This formulary is a list of covered drugs selected by Presbyterian Senior Care (HMO) and Presbyterian Dual Plus (HMO D-SNP) in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. These plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Presbyterian Senior Care (HMO) and Presbyterian Dual Plus (HMO D-SNP) network pharmacy and other plan rules are followed.

Search the 2026 Online Formularies


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2026 Medicare Formulary (List of Covered Drugs) - Updated 10/15/2025

2026 Presbyterian Dual Plus (HMO D-SNP) Formulary (List of Covered Drugs) - Updated 10/15/2025

2026 Medicare Drug Formulary Changes - Updated 10/15/2025

Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include:

Prior Authorization

Presbyterian Senior Care (HMO) and Presbyterian Dual Plus (HMO D-SNP) requires you or your provider to get prior authorization for certain drugs.


2026 Medicare Drug Prior Authorization Criteria - Updated 10/15/2025

Quantity Limits

For certain drugs, Presbyterian Senior Care (HMO) and Presbyterian Dual Plus (HMO D-SNP) limits the amount of the drug that Presbyterian Senior Care (HMO) and Presbyterian Dual Plus (HMO D-SNP) will be covered.


2026 Medicare Quantity Limits Criteria - Updated 10/15/2025

Step Therapy

In some cases, Presbyterian Senior Care (HMO) and Presbyterian Dual Plus (HMO D-SNP) requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition.


2026 Medicare Step Therapy Criteria - Updated 10/15/2025

Can the formulary (drug list) change?

The Presbyterian Medicare Advantage Formulary may change during the year. Generally, if you are taking a drug on our 2026 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2026 coverage year except when a drug has been found to be unsafe, ineffective, or you can save additional money. All changes will be listed in the Notification of Formulary Changes.


2026 Medicare Drug Formulary Changes - Updated 10/15/2025

What if my drug is not on the formulary?

If your drug is not included in this formulary (list of covered drugs), you should contact the Presbyterian Customer Service Center and ask if your drug is covered.

Presbyterian Senior Care: 505-923-6060 or 1-800-797-5343  (TTY 711) Presbyterian Dual Plus: 505-923-7675 or 1-855-465-7737 (TTY 711) Hours: Available October 1 to March 31: 8 a.m. to 8 p.m., seven days a week (except holidays) and April 1 to September 30: 8 a.m. to 8 p.m., Monday to Friday (except holidays)

If you learn that our plan does not cover your drug, you have two options:

  1. You can ask customer service for a list of similar drugs that are covered by our plan. When you receive the list, show it to your provider and ask them to prescribe a similar drug that is covered by our plan.

  2. You can ask Presbyterian Senior Care (HMO) or Presbyterian Dual Plus (HMO D-SNP) to make an exception and cover your drug. A drug formulary exception can be requested by phone, fax, mail, or online.

Learn more about requesting a drug formulary exception