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3-Tier Group Formulary WITHOUT Prior Authorization and Step Therapy

WELCOME

We cover both brand name and generic drugs. Generic drugs have the same active ingredient as brand name drugs but usually cost less and are considered by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

WHAT IS A FORMULARY?

A formulary is a list of drugs covered on a prescription drug plan.  We carefully select prescription therapies believed to be a necessary part of a quality treatment program.  A drug listed on our formulary is generally covered if the drug is used for a medically accepted use, the prescription is filled at a network pharmacy, and other plan rules are followed.  For more information on how to fill your prescriptions, please review your Evidence of Coverage (EOC).

 


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Therapeutic Class Search Skip to Footer

  • Analgesics
  • Anesthetics
  • Anti-Addiction/Substance Abuse Treatment Agents
  • Antibacterials
  • Anticonvulsants
  • Antidementia Agents
  • Antidepressants
  • Antiemetics
  • Antifungals
  • Antigout Agents
  • Antimigraine Agents
  • Antimyasthenic Agents
  • Antimycobacterials
  • Antineoplastics
  • Antiparasitics
  • Antiparkinson Agents
  • Antipsychotics
  • Antispasticity Agents
  • Antivirals
  • Anxiolytics
  • Bipolar Agents
  • Blood Glucose Regulators
  • Blood Products And Modifiers
  • Cardiovascular Agents
  • Central Nervous System Agents
  • Contraceptives
  • Dental And Oral Agents
  • Dermatological Agents
  • Electrolytes/Minerals/Metals/Vitamins
  • Gastrointestinal Agents
  • Genetic Or Enzyme Or Protein Disorder: Replacement, Modifiers, Treatment
  • Genitourinary Agents
  • Hormonal Agents, Stimulant/Replacement/Modifying (Adrenal)
  • Hormonal Agents, Stimulant/Replacement/Modifying (Pituitary)
  • Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)
  • Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)
  • Hormonal Agents, Suppressant (Adrenal)
  • Hormonal Agents, Suppressant (Pituitary)
  • Hormonal Agents, Suppressant (Thyroid)
  • Immunological Agents
  • Inflammatory Bowel Disease Agents
  • Metabolic Bone Disease Agents
  • Miscellaneous Supplies
  • Ophthalmic Agents
  • Otic Agents
  • Respiratory Tract/Pulmonary Agents
  • Skeletal Muscle Relaxants
  • Sleep Disorder Agents
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Formulary Id: 25367
Formulary Effective Date: 05/01/2025
Updated:
05/2025

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