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Important Message About What You Pay for Vaccines
– Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible. Call Member Services 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, even if you haven’t paid your deductible.
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Analgesics
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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 (Pituitary)
Hormonal Agents, Suppressant (Thyroid)
Immunological Agents
Inflammatory Bowel Disease Agents
Metabolic Bone Disease Agents
Ophthalmic Agents
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Respiratory Tract/ Pulmonary Agents
Skeletal Muscle Relaxants
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Terms of Use
Formulary Id:
24513
Formulary Effective Date:
11/01/2024
Updated:
11/2024
CMS Approval Date:
10/22/2024
CMS Version:
17
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