TRS Care Medicare Rx Formulary

The TRS Care Medicare Rx Formulary is the list of prescription drugs covered under the Texas Retiree Health Care System (TRS) for eligible Medicareeligible retirees and their dependents. This page provides a concise guide to understanding how the formulary works, how to find covered medications, and what steps to take if you need a drug that isnt on the list.

Why a Formulary Matters

A formulary is a negotiated, evidencebased compilation of prescription medicines that a health plan agrees to cover. By selecting drugs that provide the best balance of safety, effectiveness, and cost, TRS Care can keep premiums affordable while ensuring members receive clinically appropriate therapy.

Key Features of the TRS Care Medicare Rx Formulary

• Tiered Structure Medications are organized into tiers (Tier 14) that reflect generic status, therapeutic value, and price.
• Preferred Drugs Certain brandname drugs are listed as preferred and have lower copays than nonpreferred alternatives.
• Therapeutic Interchange If a prescribed drug has a lowercost, therapeutically equivalent option on the formulary, the plan may require a switch.
• Prior Authorization Some highercost or specialty drugs require approval before they can be dispensed.
• Formulary Updates The list is reviewed annually and updated in January. Changes are communicated via email, mail, and the TRS Care website.

Understanding the Tier System

How to Check If a Medication Is Covered

1. Visit the TRS Care Formulary Search page.
2. Enter the medication name or NDC code.
3. Review the tier placement, any priorauthorization requirements, and the associated copay.
4. If the drug is listed as nonformulary, note the alternative options suggested.

What to Do If Your Prescribed Drug Is Not Covered

There are three main pathways to obtain a needed medication that is not on the formulary:

• Therapeutic Substitution Ask your prescriber for a formularycovered alternative that offers the same clinical benefit.
• Prior Authorization Your prescriber can submit a request detailing why the nonformulary drug is medically necessary.
• Appeal Process If the request is denied, you may appeal the decision following the plans appeal guidelines.

Specialty Pharmacy & MailOrder Options

TRS Care contracts with a designated specialty pharmacy for Tier 4 drugs. Members can also use the plans mailorder service for most Tier 1 and Tier 2 medications, which often reduces the copay by1015percent.

Commonly Asked Questions

1. Does the formulary cover overthecounter (OTC) medications?

No. The formulary only includes prescriptiononly products. However, certain OTC items may be reimbursed under a separate plan benefit if a doctor writes a prescription for them.

2. Will my copay change if I switch from a brandname drug to its generic?

Yes. Generic drugs are typically Tier1 and have the lowest copay. Switching can save you $10$25 per prescription.

3. How often does the formulary change?

The formulary is updated once a year, with an effective date of January1. Emergency additions may occur midyear for newly approved or critical therapies.

4. Can I appeal a formulary exclusion?

Yes. You have the right to request a coverage exception. The appeal must include clinical justification and may involve a review by an external peerreviewer.

Resources

• Download Current Formulary (PDF)
• Pharmacy Services Overview
• Member Services Contact Center
• Appeal Procedure Guide

Understanding the TRS Care Medicare Rx Formulary helps you make informed decisions about your prescription therapy, control costs, and stay compliant with plan requirements. Keep this page bookmarked and check back after each annual update to ensure you have the latest information.