Drug Search Main Content

3-Tier Commercial 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 Total Health Care pharmacy benefit manager, at 844-222-5584.

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*adhd/anti-narcolepsy/anti-obesity/anorexiants**amebicides**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**calcium channel blockers**cardiotonics**cardiovascular agents - misc.**cephalosporins**chemicals**contraceptives**corticosteroids**cough/cold/allergy**dermatologicals**diagnostic products**dietary products/dietary management 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**local anesthetics-parenteral**macrolides**medical devices and supplies**medical devices**migraine products**minerals & electrolytes**mouth/throat/dental agents**multivitamins**musculoskeletal therapy agents**nasal agents - systemic and topical**neuromuscular agents**nutrients**ophthalmic agents**otic agents**oxytocics**passive immunizing agents**penicillins**pharmaceutical adjuvants**progestins**psychotherapeutic and neurological agents - misc.**respiratory agents - misc.**sulfonamides**tetracyclines**thyroid agents**ulcer drugs**urinary anti-infectives**urinary antispasmodics**vaccines**vaginal products**vasopressors**vitamins*
©1997-2018 Managed Markets Insight and Technology, LLC. All Rights Reserved | Terms of Use
Formulary Id: 0001234
Formulary Effective Date: 12/01/2018
Updated:
12/2018
CMS Approval Date:
03/01/2016
CMS Version:
1

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