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2026 5-Tier Direct Pay Formulary

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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
  • Antiallergy
  • Antiarthritics
  • Antiasthmatics
  • Antibiotics
  • Anticoagulants
  • Antidotes
  • Antifungals
  • Antihistamines
  • Antihyperglycemics
  • Antiinfectives/Miscellaneous
  • Antiinflam.Tumor Necrosis Factor Inhibiting Agents
  • Antineoplastics
  • Antiparasitics
  • Antiparkinson Drugs
  • Antiplatelet Drugs
  • Antivirals
  • Autonomic Drugs
  • Biologicals
  • Blood
  • Cardiac Drugs
  • Cardiovascular
  • Cns Drugs
  • Colony Stimulating Factors
  • Contraceptives
  • Diuretics
  • Eent Preps
  • Elect/Caloric/H2o
  • Gastrointestinal
  • Hormones
  • Immunosuppressants
  • Miscellaneous Medical Supplies, Devices, Non-Drug
  • Muscle Relaxants
  • Pre-Natal Vitamins
  • Psychotherapeutic Drugs
  • Sedative/Hypnotics
  • Skin Preps
  • Smoking Deterrents
  • Thyroid Preps
  • Unclassified Drug Products
  • Vitamins
©1997-2025 Managed Markets Insight and Technology, LLC. All Rights Reserved Terms of Use
Formulary Id: 26059
Formulary Effective Date: 10/15/2025
Updated:
11/2025
CMS Approval Date:
10/15/2025
CMS Version:
13

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