Tufts Medicare Preferred uses a Formulary to list the prescription
drugs that we cover. Follow the instructions below to find the drug
you are looking for.
To search the Formulary (Drug List):
- Open the document by clicking on the link below.
- When open, click "Edit" from the menu at the top of the page.
- From the Edit menu that opens, click "Find (on this page)."
- This will open a search window on the right side of your screen.
- Type in the drug name or category that you wish to search for and click the Search button.
- This will take you to the location of the drug or category within the Formulary. You will also be able to see what Tier your drug is on, and any limitations that may apply to that drug.
- If you would like to search for another drug or category, simply click the New Search button.
- To exit the search function, simply click the Hide button.
Changes and Updates
Tufts Medicare Preferred may add or remove drugs from our formulary during the year. The cover page of the posted formulary includes the last date the document was updated. For Prescription drug related questions only, call 7 days a week 8:00 a.m. to 8:00 p.m.
- Members: 1-800-701-9000 (TTY 1-800-208-9562)
- Prospective Members: 1-800-890-6600 (TTY 1-888-899-8977)
Pharmacy Directory
Tufts Medicare Preferred has contracts with over 850 pharmacies within the service area. The link below provides a list of Tufts Medicare Preferred participating pharmacies. This directory is updated daily, however this does not guarantee the pharmacy is still in the network. Please call Customer Relations at 1-800-701-9000 (TTY 1-800-208-9562) Monday - Friday, 8:00 a.m. - 8:00 p.m.
(Representatives are available 7 days a week, 8:00 a.m - 8:00 p.m. from Nov 15 - Mar 1). After hours and on holidays, please leave a message and a representative will return your call the next business day.
Pharmacy Finder
Our Pharmacy Directory gives you a complete list of our network pharmacies - that means all of the pharmacies that have agreed to fill covered prescriptions for our plan members. In most cases, your prescriptions are covered only if they are filled at the plan's network pharmacies (retail or mail-order). Tufts Medicare Preferred HMO and PDP has contracts with Pharmacies that equal or exceed requirements for pharmacy access in your area.
If you are traveling within the U.S., but outside of the Plan's service area and you become ill or if you lose or run out of your prescription drugs, we will cover prescriptions that are filled at an out-of-network pharmacy if you follow all other coverage rules identified within your Evidence of Coverage and a network pharmacy is not available. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill the prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form.
There may be other times you can get your prescription covered if you go to an out-of-network pharmacy. We will cover your prescription at an out-of-network pharmacy if at least one of the following applies:
- If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour
service
- If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other
specialty pharmaceuticals).
Before you fill your prescription in either of these situations, call Customer Relations to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an
out-of-network pharmacy for the reasons listed above, you will have to pay the full cost (rather than just paying your copayment) when you fill your prescription. You can ask us to reimburse
you for our share of the cost by submitting a claim form.
For a list of Tufts Medicare Preferred participating retail, mail order, home-infusion, and long-term care pharmacies, as well as toll-free numbers for participating national chain pharmacies, click here:
HMO
PDP
Appeals and Grievances
Interested in learning more about the aggregate number of appeals, grievances and exceptions filed with Tufts Medicare Preferred? Call Customer Relations for a copy of our Tufts Medicare Preferred HMO and PDP Appeals and Grievances Report at 1-800-701-9000 (TTY 1-800-208-9562) Monday - Friday, 8:00 a.m. - 8:00 p.m. (Representatives are available 7 days a week, 8:00 a.m - 8:00 p.m. from Nov 15 - Mar 1). After hours and on holidays, please leave a message and a representative will return your call the next business day.
