List of Drugs (Formulary)

            Updated December 1, 2022:

You can ask us to make an exception to our rules for your drug(s). To learn how, read your Evidence of Coverage. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.

Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You can ask for a fast (expedited) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s statement.

List of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before the following changes are made to the list of drugs:

• Remove a drug from the list.
• Change drug requirements.
• Move a drug to a higher cost sharing tier.

If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug.

List of Drugs (Formulary)

How Do I Search for a Drug in the List of Drugs (Formulary)?

You can search for a drug by using our Drug Search Tool or by opening the List of Drugs (Formulary) PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives. 

The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the PDF drug list. The drug list is updated monthly.

            Last Updated October 15, 2022:

List of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before one the following changes are made to the list of drugs:

• Remove a drug from the list.
• Change drug requirements.
• Move a drug to a higher cost sharing tier.

If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug. To view the changes, open the List of Drug Change Notice PDF document below.

Drug Coverage Determinations

You can ask us to make an exception to our rules for your drug(s). To learn how, read your Evidence of Coverage. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.

Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You can ask for a fast (expedited) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s statement.

Generic Drugs

We cover both brand name drugs 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. 

Ask your doctor if any of your drugs are available as a generic, and if the generic version would work for you. Generic medications are FDA-approved, have the same active ingredients, indications, dosages, safety and strengths as the brand name medications and generally cost less.

Mail Order Service

You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service—CVS/Caremark®. You can find more information about receiving your prescriptions through mail service delivery on our Mail Order Service page.