A formulary is a list of covered drugs created in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.
The covered drugs are listed on the formulary as long as the medication is medically necessary, the prescription is filled at an in-network pharmacy, and other plan rules are followed. Please review your Evidence of Coverage for more detailed information about your formulary and how to fill your prescriptions.
If a drug is not listed in your drug formulary, the product is not covered under your pharmacy benefit. If you decide to fill a prescription for a product not on the formulary, you are responsible for 100% of the cost. The cost is also not counted toward deductibles or out-of-pocket maximums.
2023 comprehensive formulary updated 6/1/23
If you have a question about covered drugs or would like a formulary mailed to you, call our Customer Care Center at 1-877-301-3326 (TTY: 711).