Formulary Search

To Search: Please enter a drug name, or at least the first few letters of a drug name, then click "GO." To view all the drugs in the formulary, type an *. Click here to search Drug
 

What is a Formulary?
A formulary is a list of drugs selected by us in consultation with a team of health care providers. This list represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information please review the Evidence of Coverage booklet.

Generic vs. Brand-Name Drugs
We cover both brand-name and generic drugs. Generic drugs have the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

Formulary Updates
This formulary may change during the year. If we remove drugs from our formulary, or add prior authorization, and/or quantity limits on a drug or move a drug to a higher cost-sharing tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60- day supply of the 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 will immediately remove the drug from our formulary and provide notice to members who take the drug.

How to Get an Exception
Please contact us for an initial coverage decision about an exception. Submit a statement from your physician supporting your request. Generally, we must make our decision within 72 hours of your request.
 
Exceptions you can request are:

  • Covering your drug even if it is not on our formulary.
  • Waiving coverage restrictions or limits on your drug. For example, if your drug has a quantity limit, you can ask us to waive the limit and cover more.
  • Providing a higher level of coverage for your drug. For example if your drug is a tier 3 or tier 4 you can ask us to cover it at a lower tier (tier 2 or tier 3), to lower what you pay.

For more information about exceptions, please refer to the Evidence of Coverage booklet.

 

CMS FORMULARY SEARCH