List of Drugs Formulary
Alternative Drug List
List of Drugs Change Notice
Prior Authorization Criteria
Step Therapy Criteria
Quantity Limits
Drug Coverage Determination (exceptions)
Generic Drugs
Mail Order Service
Listaan dagiti Agas (Pormulario)
Our list of drugs (formulary) shows the drugs that we cover. In general, we cover your drugs if they are medically necessary. Drugs on our list of drugs are covered when you use our network pharmacies or mail order service for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. We don't include all drugs. Some drugs we cover have limits or other rules. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
TI Komite ti Parmasia ken Therapeutics, ti grupomi kadagiti independiente nga ekspero ti panangtaripato iti salun-at, ket mangsuksukimat ken mangap-aprobar ti listaan dagiti agasmi. Saanmi nga iraman amin nga agas. Ti sumagmamano nga agas ket mabalin a saan a nasakup wenno nailaksid. Dagiti sabali nga agas ket awan iti listaan gapu kadagiti rason a klinikal ken gastos.
Kasanonak nga Agbirok para ti Agas iti Listaan dagiti Agas (Pormulario)?
Mabalinmo a birukan ti agas babaen ti panagusar ti Ramit a Pangbirok ti Agas wenno babaen ti panagilukat ti dokumento iti Listaan dagiti Agas (Pormulario). Ti kada keddeng ket mangipakpakita kenka ti kompleto a listaan dagiti agas ken dagiti aniaman a restriksion wenno beddeng. Ti ramit a pangbirok ket ipakpakitana met dagiti nasakup nga alternatibo iti agas.
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 drug list as a PDF document. The drug list is updated monthly.
Mabalinmo a mabirukan ti Ramit ti Pangbirok ti Listaan dagiti Agas (pormulario) iti sidebar navigation.
You can find the List of Drugs (formulary) as a PDF document on the Drug List (Formulary) and Other Documents page in the sidebar navigation (within the Pharmacy section).
Alternative Drugs List
Are you currently taking a drug that is not covered on your plan’s List of Drugs (formulary)? The form below is a partial list of some common drugs that are not covered, along with their covered alternative drugs. Talk to your provider to see if the drug alternatives listed in the PDF below will work for you.
2025 Plans: Alternative Covered Drug List (PDF)
2026 Plans: Alternative Covered Drug List (PDF)
Pakaammo ti Panagbaliw ti Listaan dagiti Agas
Our drug list (formulary) can change during the year. Most changes in drug coverage happen at the beginning of the year. However, during the year, our plan can make changes to the drug list. Generally, we will tell you before we make any of the following mid-year changes:
- Add or remove drugs from the list
- Move a drug to a higher or lower cost-sharing tier
- Add or remove a restriction on coverage for a drug
- Replace a brand name drug with a generic version of the drug
- Replace an original biological product with an interchangeable biosimilar version of the biological product
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe or is taken off the market for another reason, 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.
You can find the List of Drugs - Change Notice as a PDF document on the Drug List (Formulary) and Other Documents page in the sidebar navigation (within the Pharmacy section).
Naiyuna nga Autorisasion, Step Therapy ken Dagiti Beddeng ti Kinaadu
- Prior Authorization: We require you to get approval from us before we agree to cover certain drugs. We call this prior authorization. If you don’t get approval, you may be asked to pay for the drug. Drugs that require a prior authorization are noted with a “PA" or "PA-NS” on the List of Drugs (formulary).
- Step Therapy: Iti sumagmamano a kaso, ikasapulan da ka a padasen nga umuna ti partikular nga agas tapno agasan ti medikal a kondisionmo sakbaymi a sakupen ti sabali nga agas para ti dayta a kondision. Daytoy a kasapulan a padasen nga umuna ti sabali nga agas ket maawagan a kas step therapy. Dagiti agas nga agkasapulan ti step therapy ket nainotar iti “ST” iti Listaan dagiti Agas (pormulario).
- Dagiti Beddeng ti Kinaadu: Para kadagiti partikular nga agas, beddenganmi ti kaadu ti agas a sakupenmi. Kas pangarigan, maysa a tableta kada aldaw. Daytoy ket mabalin a mainayaon iti kadawyan a maysa a bulan wenno tallo a bulan a suplay. Dagiti agas nga agkasapulan kadagiti beddeng ti kinaadu ket nainotar iti “QL” iti Listaan dagiti Agas (pormulario).
You can find the Prior Authorization Criteria and the Step Therapy Criteria forms as PDF documents on the Drug List (Formulary) and Other Documents page in the sidebar navigation (within the Pharmacy section).
Dagiti Panangamiris ti Masakupan ti Agas
You can ask us to make an exception to our coverage rules for your drug(s). To learn about the types of exceptions, refer to 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 within 72 hours of getting your doctor’s supporting statement. You or your doctor can request a fast (expedited) exception if your health may be harmed by waiting. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s supporting statement.
You can find the Coverage Determination forms at the bottom of the Pharmacy page found in the sidebar navigation.
Dagiti Generic nga Agas
We cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs are FDA-approved, and are as safe and effective as brand name drugs. They have the same active ingredients, indications, dosages, safety, and strengths as the brand name drugs and generally cost less. Ask your doctor if any of your drugs are available as a generic, and if a generic version will work for you.
Serbisio ti Bilin iti Korreo
You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service. This can save you time, money, and trips to the Pharmacy.
Find more information about receiving your prescriptions through mail service delivery on the Mail Order Service page.
