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MA-PD Formulary (2025)
Classic Plan (HMO-POS), Value Plan (HMO), Rewards Plan (HMO), Complete Care (HMO), Emerald Plus (HMO), Easy Access(HMO-POS)

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  • Analgesics
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  • Anti-Addiction/ Substance Abuse Treatment Agents
  • Antibacterials
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  • Antidementia Agents
  • Antidepressants
  • Antiemetics
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  • Antigout Agents
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  • Antimycobacterials
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  • Dental And Oral Agents
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  • 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 (Prostaglandins)
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Sex Hormones/ Modifiers)
  • Hormonal Agents, Stimulant/ Replacement/ Modifying (Thyroid)
  • Hormonal Agents, Suppressant (Adrenal Or Pituitary)
  • Hormonal Agents, Suppressant (Thyroid)
  • Immunological Agents
  • Inflammatory Bowel Disease Agents
  • Metabolic Bone Disease Agents
  • Non-Frf Drugs
  • Ophthalmic Agents
  • Otic Agents
  • Respiratory Tract/ Pulmonary Agents
  • Skeletal Muscle Relaxants
  • Sleep Disorder Agents
©1997-2024 Managed Markets Insight and Technology, LLC. All Rights Reserved Terms of Use
Formulary Id: 25520
Formulary Effective Date: 01/01/2025
Updated:
11/2024
CMS Approval Date:
08/26/2024
CMS Version:
14

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