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2021 Commercial 5 Tier Formulary - Non-Qualified Health Plans [do not contain Platinum, Gold, Silver, Bronze, or Catastrophic in the name]


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Analgesic, Anti-Inflammatory Or AntipyreticAnestheticsAnorectal PreparationsAntidotes And Other Reversal AgentsAnti-Infective AgentsAntineoplasticsBiologicalsCardiovascular Therapy AgentsCentral Nervous System AgentsChemical Dependency, Agents To TreatChemicals-Pharmaceutical AdjuvantsCognitive Disorder TherapyContraceptivesDermatologicalDiagnostic AgentsEating Disorder TherapyElectrolyte Balance-Nutritional ProductsEndocrineGastrointestinal Therapy AgentsGenitourinary TherapyGout And Hyperuricemia TherapyHematological AgentsImmunosuppressive AgentsLocomotor SystemMedical Supplies And Durable Medical Equipment (Dme)Medical Supply, Fdb SupersetMetabolic Disease Enzyme Replacement AgentsMetabolic ModifiersMouth-Throat-Dental - PreparationsMultiple Sclerosis AgentsOphthalmic AgentsOtic (Ear)Respiratory Therapy AgentsVaginal Products
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Formulary Effective Date: 11/01/2021
Updated:
12/2021
CMS Approval Date:
09/24/2021
CMS Version:
4

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