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Analgesics
Anesthetics
Anti-Addiction/Substance Abuse Treatment Agents
Antibacterials
Anticonvulsants
Antidementia 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 (Prostaglandins)
Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers)
Hormonal Agents, Stimulant/Replacement/Modifying (Thyroid)
Hormonal Agents, Suppressant (Adrenal)
Hormonal Agents, Suppressant (Pituitary)
Hormonal Agents, Suppressant (Thyroid)
Immunological Agents
Inflammatory Bowel Disease Agents
Metabolic Bone Disease Agents
Miscellaneous Therapeutic Agents
Ophthalmic Agents
Otic Agents
Respiratory Tract/Pulmonary Agents
Skeletal Muscle Relaxants
Sleep Disorder Agents
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Terms of Use
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 your HealthCare Concierge for more information.
Important Message About What You Pay for Insulin
- You won’t pay more than $0 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.
Formulary Id:
00023451
Formulary Effective Date:
12/01/2023
Updated:
12/2023
CMS Approval Date:
11/21/2023
CMS Version:
17
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