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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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*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants*
*Aminoglycosides*
*Analgesics - Anti-Inflammatory*
*Analgesics - Nonnarcotic*
*Analgesics - Opioid*
*Androgens-Anabolic*
*Anorectal Agents*
*Anorectal And Related Products*
*Anthelmintics*
*Antianginal Agents*
*Antianxiety Agents*
*Antiarrhythmics*
*Antiasthmatic And Bronchodilator Agents*
*Anticoagulants*
*Anticonvulsants*
*Antidepressants*
*Antidiabetics*
*Antidiarrheals*
*Antidotes And Specific Antagonists*
*Antidotes*
*Antiemetics*
*Antifungals*
*Antihistamines*
*Antihyperlipidemics*
*Antihypertensives*
*Anti-Infective Agents - Misc.*
*Antimalarials*
*Antimyasthenic/Cholinergic Agents*
*Antimycobacterial Agents*
*Antineoplastics And Adjunctive Therapies*
*Antiparkinson Agents*
*Antiparkinson And Related Therapy Agents*
*Antipsychotics/Antimanic Agents*
*Antivirals*
*Assorted Classes*
*Beta Blockers*
*Calcium Channel Blockers*
*Cardiotonics*
*Cardiovascular Agents - Misc.*
*Cephalosporins*
*Contraceptives*
*Corticosteroids*
*Cough/Cold/Allergy*
*Dermatologicals*
*Digestive Aids*
*Diuretics*
*Endocrine And Metabolic Agents - Misc.*
*Estrogens*
*Fluoroquinolones*
*Gastrointestinal Agents - Misc.*
*Genitourinary Agents - Miscellaneous*
*Gout Agents*
*Hematological Agents - Misc.*
*Hematopoietic Agents*
*Hemostatics*
*Hypnotics/Sedatives/Sleep Disorder Agents*
*Laxatives*
*Local Anesthetics-Parenteral*
*Macrolides*
*Medical Devices And Supplies*
*Medical Devices*
*Migraine Products*
*Minerals & Electrolytes*
*Miscellaneous Therapeutic Classes*
*Mouth/Throat/Dental Agents*
*Multivitamins*
*Musculoskeletal Therapy Agents*
*Nasal Agents - Systemic And Topical*
*Neuromuscular Agents*
*Nutrients*
*Ophthalmic Agents*
*Otic Agents*
*Passive Immunizing Agents*
*Passive Immunizing And Treatment Agents*
*Penicillins*
*Progestins*
*Psychotherapeutic And Neurological Agents - Misc.*
*Respiratory Agents - Misc.*
*Sulfonamides*
*Tetracyclines*
*Thyroid Agents*
*Toxoids*
*Ulcer Drugs*
*Ulcer Drugs/Antispasmodics/Anticholinergics*
*Urinary Anti-Infectives*
*Urinary Antispasmodics*
*Vaccines*
*Vaginal Products*
*Vasopressors*
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Terms of Use
Formulary Id:
24467
Formulary Effective Date:
09/01/2024
Updated:
09/2024
CMS Approval Date:
08/20/2024
CMS Version:
15
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