Drug Search Main Content

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.  

 


Virginia Premier

Medallion 4.0 Common Core Formulary

To request an exception (PA,ST,QL,NF) please call Elixir, the Virginia Premier Health Plan pharmacy benefit manager, at 855-872-0005.

For the Machine Readable Data for Prescription Drug Formulary: VPM4 Medicaid Machine Readable File


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Brand & Generic Name Search

   

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*adhd/anti-narcolepsy/anti-obesity/anorexiants**allergenic extracts/biologicals misc**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**antidiarrheal/probiotic agents**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**antiparkinson and related therapy 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**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**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**passive immunizing and treatment agents**penicillins**pharmaceutical adjuvants**progestins**psychotherapeutic and neurological agents - misc.**respiratory agents - misc.**sulfonamides**tetracyclines**thyroid agents**toxoids**ulcer drugs**ulcer drugs/antispasmodics/anticholinergics**urinary anti-infectives**urinary antispasmodics**vaccines**vaginal and related products**vaginal products**vasopressors**vitamins*
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Formulary Effective Date: 09/01/2021
Updated:
09/2021

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