National Drug List 5-Tier with Split Generic Tier
Search by medication
name for up-to-date drug information, including the benefit tier your drugs are
on, as well as applicable clinical edits such as prior authorization or step
therapy requirements. To view a PDF version of this, or any/all of our drug lists/formularies, click here.
drugs, such as those used for cosmetic purposes, may be excluded
from your benefits. Please refer to your
insurance Certificate or Evidence of Coverage that governs
how your prescription benefits are covered.
Preventive care drugs: We cover preventive care drugs with zero cost share in compliance with the Affordable Care Act (ACA). We cover contraceptives for members enrolled in a California plan according to state regulations.
Member cost share amounts for certain abuse-deterrent opioid analgesics may be lower in the state Maine due to state laws. For additional information, please call the customer service number on your ID card.