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Therapeutic Class Search Skip to Footer

  • Analgesics
  • Anesthetics
  • Anti-Addiction/Substance Abuse Treatment Agents
  • Antibacterials
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  • Dental And Oral Agents
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  • Electrolytes/Minerals/Metals/Vitamins
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  • 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 Or Pituitary)
  • Hormonal Agents, Suppressant (Thyroid)
  • Immunological Agents
  • Inflammatory Bowel Disease Agents
  • Metabolic Bone Disease Agents
  • Miscellaneous Therapeutic Agents
  • Ophthalmic Agents
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  • Respiratory Tract/Pulmonary Agents
  • Skeletal Muscle Relaxants
  • Sleep Disorder Agents
  • Supplemental
  • Therapeutic Nutrients/Minerals/Electrolytes
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  • Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you. Call your HealthCare Concierge for more information.

  • Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.
 
Formulary Id: 00025417
Formulary Effective Date: 05/01/2025
Updated:
05/2025
CMS Approval Date:
04/22/2025
CMS Version:
13

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