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Analgesics
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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
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Metabolic Bone Disease Agents
Miscellaneous Therapeutic Agents
Ophthalmic Agents
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Respiratory Tract/Pulmonary Agents
Skeletal Muscle Relaxants
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Therapeutic Nutrients/Minerals/Electrolytes
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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. 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:
00024469
Formulary Effective Date:
11/01/2024
Updated:
11/2024
CMS Approval Date:
10/22/2024
CMS Version:
18
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