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  • Analgesic, Anti-Inflammatory Or Antipyretic
  • Anorectal Preparations
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  • Drugs To Treat Erectile Dysfunction
  • Electrolyte Balance-Nutritional Products
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  • Gout And Hyperuricemia Therapy
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  • Medical Supply, Fdb Superset
  • Metabolic Modifiers
  • Mouth-Throat-Dental - Preparations
  • Multiple Sclerosis Agents
  • Ophthalmic Agents
  • Organ Preservation Solutions
  • Otic (Ear)
  • Respiratory Therapy Agents
  • Vaginal Products
  • Weight Loss/Gain Agents
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Disclaimer
Formulary Id: 24653
Formulary Effective Date: 11/26/2025
Updated:
11/2025
CMS Approval Date:
11/28/2025
CMS Version:
41

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