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Virginia Premier Elite Plus  

Common Core Formulary

If you search for a brand named drug that is not covered, and there is a generic alternative available, that generic alternative will display. Click on the generic alternative for coverage details. If there is no generic alternative, see the details regarding exceptions.



To request an exception (PA,ST,QL,NF) please call EnvisionRx, the Virginia Premier Elite Plus pharmacy benefit manager, at 844-838-0711.

Alphabetical Search Skip to Brand & Generic Search

Brand & Generic Name Search

   

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*adhd/anti-narcolepsy/anti-obesity/anorexiants**alternative medicines**aminoglycosides**analgesics - anti-inflammatory**analgesics - nonnarcotic**analgesics - opioid**androgens-anabolic**anorectal agents**antacids**anthelmintics**antianginal agents**antianxiety agents**antiarrhythmics**antiasthmatic and bronchodilator agents**anticoagulants**anticonvulsants**antidepressants**antidiabetics**antidiarrheals**antidotes and specific antagonists**antidotes**antiemetics**antifungals**antihistamines**antihyperlipidemics**antihypertensives**anti-infective agents - misc.**antimalarials**antimyasthenic agents**antimyasthenic/cholinergic agents**antimycobacterial agents**antineoplastics and adjunctive therapies**antiparkinson agents**antipsychotics/antimanic agents**antiseptics & disinfectants**antivirals**assorted classes**beta blockers**biologicals misc**calcium channel blockers**cardiotonics**cardiovascular agents - misc.**cephalosporins**chemicals**contraceptives**corticosteroids**cough/cold/allergy**dermatologicals**diagnostic products**digestive aids**diuretics**endocrine and metabolic agents - misc.**estrogens**fluoroquinolones**gastrointestinal agents - misc.**genitourinary agents - miscellaneous**gout agents**hematological agents - misc.**hematopoietic agents**hemostatics**hypnotics**hypnotics/sedatives/sleep disorder agents**laxatives**macrolides**medical devices and supplies**medical devices**migraine products**minerals & electrolytes**miscellaneous therapeutic classes**mouth/throat/dental agents**multivitamins**musculoskeletal therapy agents**nasal agents - systemic and topical**neuromuscular agents**nutrients**ophthalmic agents**otic agents**passive immunizing agents**penicillins**pharmaceutical adjuvants**progestins**psychotherapeutic and neurological agents - misc.**respiratory agents - misc.**sulfonamides**tetracyclines**thyroid agents**toxoids**ulcer drugs**urinary anti-infectives**urinary antispasmodics**vaccines**vaginal products**vasopressors**vitamins*
©1997-2019 Managed Markets Insight and Technology, LLC. All Rights Reserved | Terms of Use
Questions?   Contact the Virginia Premier Elite Plus Pharmacy Benefit Manager EnvisionRx at 844-838-0711.
Formulary Id: 0001234
Formulary Effective Date: 02/01/2019
Updated:
02/2019
CMS Approval Date:
08/01/2017
CMS Version:
1

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