Key Updates: AEP Drug Pricing Tool & TMP Preferred Pharmacy List

Publish Date
- 01:28 pm

We are thrilled to be working with you throughout the 2024 Annual Enrollment period. We highly value the collaborative relationship we have invested in and built together.  

We want to keep you fully informed and ensure that our partnership remains transparent and effective. 
In this regard, we have two important updates to be aware of as we begin AEP:

  • The issue affecting the Medicare plan finder tool has been resolved.
  • The drug pricing tool is currently experiencing some inaccuracies and the information below provides you with the details you need to know.

AEP Drug Pricing Tool & Prescription Drug List
The 2024 drug pricing tool is now available; however, more updates will occur to fix existing coverage inaccuracies. The current drug pricing tool requires ADDITIONAL steps to validate accurate coverage.

At this time when using the tool, coverage results do not accurately reflect those drugs needing utilization management (prior authorization, step therapy or quantity limit), drugs excluded by Medicare but covered under our enhanced benefit, and drugs not covered under our formulary.  

The grid  below shows what is currently accurate and what needs to be updated. 

Drug Category

Prescription Drug List:

Drug Status

Drug Pricing Tool:

Coverage Status

Drug Pricing Tool:

Drug Pricing

Formulary:   drug is covered

[no UM* requirement(s)]

Formulary (Tier level)


Pricing is available

Formulary:   drug is covered

[w/UM* requirement(s)]

Formulary (Tier level) and

UM requirements detailed

Not Covered

Pricing is not available

Enhanced covered drug



Not Covered

Pricing is not available

Non-Formulary:   drug is not covered 



Pricing is available

Accurate information

Inaccurate information

*Utilization Management:  Prior Authorization, Step Therapy and/or Quantity Limit 


To see a plan’s accurate drug coverage, please click here for a step-by-step tutorial on how you can still validate and utilize the search.

We continue to work with OptumRX, our PBM, to fix this issue and improve the overall drug lookup process for you and your clients. We will notify you as updates occur.


Please reach out to Medicare Broker Support or your Broker Manager with any questions or issues.

Thank you for your commitment to bringing our products to market to help meet customer needs. We appreciate your business.