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2017 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 Antipyretic
Anesthetics
Anorectal Preparations
Antidotes And Other Reversal Agents
Anti-Infective Agents
Antineoplastics
Biologicals
Cardiovascular Therapy Agents
Central Nervous System Agents
Chemical Dependency, Agents To Treat
Chemicals-Pharmaceutical Adjuvants
Cognitive Disorder Therapy
Contraceptives
Dermatological
Diagnostic Agents
Eating Disorder Therapy
Electrolyte Balance-Nutritional Products
Endocrine
Gastrointestinal Therapy Agents
Genitourinary Therapy
Gout And Hyperuricemia Therapy
Hematological Agents
Immunosuppressive Agents
Locomotor System
Medical Supplies And Durable Medical Equipment (Dme)
Medical Supply, Fdb Superset
Metabolic Disease Enzyme Replacement Agents
Metabolic Modifiers
Mouth-Throat-Dental - Preparations
Multiple Sclerosis Agents
Ophthalmic Agents
Otic
Respiratory Therapy Agents
Vaginal Products
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Formulary Id:
00000000
Formulary Effective Date:
09/01/2017
Updated:
09/2017
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