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2020 Connecticut Select Drug List

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.

You can also view the full drug list here.  (Some pages of this document are intentionally left blank.)

Your coverage has limitations and exclusions, which means that some drugs on this list may not be covered, depending on your plan’s design. To find out more, please refer to your Certificate/Evidence of Coverage or your Summary Plan Description.

Most plans include our home delivery program at no extra cost to you.  Find out more by going online to anthem.com or call 866-281-2966.

To our providers: Click here to initiate an electronic prior authorization (ePA) request.


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*5-HT4 RECEPTOR AGONISTS****ADENOSINE DEAMINASE SCID TREATMENT - AGENTS****ADENOSINE RECEPTOR ANTAGONIST****ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS**AGENTS FOR NARCOTIC WITHDRAWAL****AGENTS FOR OPIOID WITHDRAWAL****AGENTS FOR SUBMENTAL FAT****ALS AGENTS - MISCELLANEOUS****ALTERNATIVE MEDICINE - AG'S****ALTERNATIVE MEDICINE - DA'S****ALTERNATIVE MEDICINE - LA'S***ALTERNATIVE MEDICINE - LI'S****ALTERNATIVE MEDICINE - OS****ALTERNATIVE MEDICINE - PE'S****ALTERNATIVE MEDICINE - WO'S****ALTERNATIVE MEDICINES**AMEBICIDES**AMINO ACIDS****AMINOGLYCOSIDES**AMINOMETHYLCYCLINES****ANALGESIC COMBINATIONS - TOPICAL****ANALGESICS - ANTI-INFLAMMATORY**ANALGESICS - NONNARCOTIC**ANALGESICS - OPIOID**ANDROGEN COMBINATIONS****ANDROGENS-ANABOLIC**ANORECTAL AGENTS**ANTACIDS**ANTHELMINTICS**ANTIANGINAL AGENTS**ANTIANXIETY AGENTS**ANTIARRHYTHMICS**ANTIASTHMATIC AND BRONCHODILATOR AGENTS**ANTICOAGULANTS - MISC.****ANTICOAGULANTS**ANTICONVULSANTS**ANTIDEMENTIA AGENT COMBINATIONS****ANTIDEPRESSANTS**ANTIDIABETICS**ANTIDIARRHEAL/PROBIOTIC AGENTS**ANTIDIARRHEALS**ANTIDOTE COMBINATIONS****ANTIDOTES AND SPECIFIC ANTAGONISTS**ANTIDOTES**ANTIEMETICS**ANTIFUNGALS**ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES****ANTIHISTAMINES**ANTIHYPERLIPIDEMICS MISC. COMBINATIONS****ANTIHYPERLIPIDEMICS**ANTIHYPERTENSIVES**ANTI-INFECTIVE AGENTS - MISC.**ANTIMALARIALS**ANTIMYASTHENIC AGENTS**ANTIMYASTHENIC/CHOLINERGIC AGENTS**ANTIMYCOBACTERIAL AGENTS**ANTINEOPLASTIC - BCL-2 INHIBITORS****ANTINEOPLASTIC - BISPECIFIC T-CELL ENGAGERS****ANTINEOPLASTIC - FGFR KINASE INHIBITORS****ANTINEOPLASTIC - HORMONAL AND RELATED AGENT COMBINATIONS****ANTINEOPLASTIC - TROPOMYOSIN RECEPTOR KINASE INHIBITORS****ANTINEOPLASTIC - XPO1 INHIBITORS****ANTINEOPLASTIC OR PREMALIGNANT LESION AGENT - COMB****ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES**ANTI-OBESITY - GLP-1 RECEPTOR AGONISTS****ANTI-OBESITY AGENT COMBINATIONS***ANTIPARKINSON AGENTS**ANTIPSORIATIC COMBINATIONS****ANTIPSYCHOTICS/ANTIMANIC AGENTS**ANTIRETROVIRALS - CD4-DIRECTED POST-ATTACHMENT INHIBITOR****ANTIRETROVIRALS ADJUVANTS****ANTISENSE OLIGONUCLEOTIDE (ASO) INHIBITOR AGENTS****ANTISEPTICS & DISINFECTANTS**ANTIVIRALS**ANTI-VON WILLEBRAND FACTOR AGENTS****ASSORTED CLASSES**ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES****BACTERIAL MONOCLONAL ANTIBODIES****B-COMPLEX W/ E & FOLIC ACID****BETA BLOCKERS**BILE ACID SYNTHESIS DISORDER AGENTS****BIOLOGICALS MISC**BIOTIN W/ VITAMINS C & E****BULK CHEMICALS - KU****BULK CHEMICALS - NY****BULK CHEMICALS - OS****BULK CHEMICALS - ZO'S****CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG****CALCIUM CHANNEL BLOCKERS**CARDIOTONICS**CARDIOVASCULAR AGENTS - MISC.**CASTS, SPLINTS & ACCESSORIES****CEPHALOSPORIN COMBINATIONS****CEPHALOSPORINS**CHEMICALS**CIC AGENTS - GUANYLATE CYCLASE-C (GC-C) AGONISTS****CONTRACEPTIVES**CORTICOSTEROIDS**COUGH/COLD/ALLERGY**CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS****CYSTIC FIBROSIS AGENT - COMBINATIONS****DERMATOLOGICALS**DIAGNOSTIC PRODUCTS**DIAGNOSTIC RADIOPHARMACEUTICALS - GASES****DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS**DIGESTIVE AIDS**DIGESTIVE ENZYME CARTRIDGE****DIGITAL THERAPY****DIRECT-ACTING P2Y12 INHIBITORS****DIURETICS**DOPAMINE AND NOREPINEPHRINE REUPTAKE INHIBITORS (DNRIS)****ENDOCRINE AND METABOLIC AGENTS - MISC.**ESTROGEN COMBINATIONS****ESTROGEN-ANDROGEN-PROGESTIN****ESTROGENS**ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB****FARNESOID X RECEPTOR (FXR) AGONISTS****FENTANYL COMBINATIONS****FLUOROCYCLINES****FLUOROQUINOLONES**GABA RECEPTOR MODULATOR - NEUROACTIVE STEROID****GASTROINTESTINAL AGENTS - MISC.**GENERAL ANESTHETICS**GENITOURINARY AGENTS - MISCELLANEOUS**GLYCOPEPTIDES****GOUT AGENTS**HEMATOLOGICAL AGENTS - MISC.**HEMATOPOIETIC AGENTS**HEMOSTATICS**HEPATITIS C AGENT - COMBINATIONS****HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS***HYPNOTIC COMBINATIONS****HYPNOTICS**HYPOPHOSPHATASIA (HPP) AGENTS****IBS AGENT - 5-HT4 RECEPTOR PARTIAL AGONISTS****IBS AGENT - MU-OPIOID RECEPTOR AGONISTS****IMPOTENCE AGENT COMBINATIONS****IMPOTENCE AGENTS - OTHER****IN VITRO ANTICOAGULANT COMBINATIONS****IN VITRO/LOCK ANTICOAGULANT COMBINATIONS****IN VITRO/LOCK ANTICOAGULANTS****INSULIN-INCRETIN MIMETIC COMBINATIONS****INTEGRIN RECEPTOR ANTAGONISTS****INTERLEUKIN ANTAGONISTS****INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)****INTERLEUKIN-5 ANTAGONISTS (IGG4 KAPPA)****INTERLEUKIN-6 (IL-6) ANTAGONISTS****ISOCITRATE DEHYDROGENASE-1 (IDH1) INHIBITORS****ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS****LAXATIVES**LEPTIN ANALOGUES****LHRH/GNRH AGONIST ANALOG COMBINATIONS****LOCAL ANESTHETICS-PARENTERAL**LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG****LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS****MACROLIDES**MEDICAL DEVICES**MEDICATION DISPOSAL SYSTEMS****MELANOCORTIN RECEPTOR AGONISTS****MIGRAINE PRODUCTS**MINERALS & ELECTROLYTES**MISCELLANEOUS THERAPEUTIC CLASSES**MIXED ALLERGENIC EXTRACTS****MONOBACTAMS****MOUTH/THROAT/DENTAL AGENTS**MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS****MUCOPOLYSACCHARIDOSIS VII (MPS VII) - AGENTS****MULTIPLE SCLEROSIS AGENTS - ANTIMETABOLITES****MULTIPLE VITAMINS & FLUORIDE-FOLIC ACID****MULTIPLE VITAMINS W/ MINERALS & FLUORIDE-IRON-FOLIC ACID****MULTIPLE VITAMINS WITH FOLIC ACID****MULTIVITAMINS**MUSCULAR DYSTROPHY AGENTS****MUSCULOSKELETAL THERAPY AGENTS**NASAL AGENTS - SYSTEMIC AND TOPICAL**NASAL ANESTHETICS****NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB****NEUROGENIC ORTHOSTATIC HYPOTENSION (NOH) - AGENTS****NEUROMUSCULAR AGENTS**N-METHYL-D-ASPARTIC ACID (NMDA) RECEPTOR ANTAGONISTS****NSAID-DIETARY MANAGEMENT COMBINATIONS****NSAID-VITAMINS AND/OR MINERALS COMBINATIONS****NUTRIENTS**ONCOLYTIC VIRAL AGENTS - HSV1****OPHTHALMIC AGENTS**OPHTHALMIC KINASE INHIBITORS - COMBINATIONS****OPHTHALMIC LOCAL ANESTHETIC - COMBINATIONS****OPHTHALMIC PHOTOENHANCER COMBINATIONS****OPHTHALMIC RHO KINASE INHIBITORS****OPIOID ANTAGONIST COMBINATIONS****OREXIN RECEPTOR ANTAGONISTS****OTIC AGENTS**OXABOROLE-RELATED ANTIFUNGALS - TOPICAL****OXYTOCICS**PA ENDONUCLEASE INHIBITORS****PASSIVE IMMUNIZING AGENTS - COMBINATIONS****PASSIVE IMMUNIZING AGENTS**PCSK9 INHIBITORS****PEDIATRIC MULTIPLE VITAMINS & MINERALS W/ FLUORIDE****PEDIATRIC MULTIPLE VITAMINS W/FLUORIDE-IRON-ZINC****PENICILLINS**PERITONEAL DIALYSIS SOLUTIONS****PHARMACEUTICAL ADJUVANTS**PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS****PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL****PHOSPHODIESTERASE 4 (PDE4) INHIBITORS****PLASMA KALLIKREIN INHIBITORS - MONOCLONAL ANTIBODIES****PLEUROMUTILINS****POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS***POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS****POSTHERPETIC NEURALGIA (PHN) COMBINATION AGENTS****POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS****POSTHERPETIC NEURALGIA(PHN)/NEUROPATHIC PAIN COMB AGENTS****POTASSIUM REMOVING AGENTS****PRENATAL MV & MIN W/FE-FA & COENZYME Q10****PRENATAL MV & MINERALS W/ FA WITHOUT IRON****PRENATAL MV & MINERALS W/ FA-OMEGA FATTY ACIDS W/O IRON****PRENATAL MV & MINERALS W/FA WITHOUT IRON****PROGESTINS**PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS****PROTEIN-CARBOHYDRATE-LIPID WITH ELECTROLYTE COMBINATIONS****PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.**PULMONARY FIBROSIS AGENTS - KINASE INHIBITORS****PULMONARY FIBROSIS AGENTS****PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST****RESPIRATORY AGENTS - MISC.**SCAR TREATMENT PRODUCTS - COMBINATIONS****SCLEROSTIN INHIBITORS****SEBORRHEIC KERATOSIS PRODUCTS***SEIZURE MONITORING PRODUCTS****SEMI SOLID VEHICLE COMBINATIONS***SEPTAL AGENTS - ABLATION***SEROTONIN 1A RECEPT AGONIST/SEROTONIN 2A RECEPT ANTAG****SEROTONIN MODULATORS****SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS****SINUS NODE INHIBITORS***SMALL INTERFERING RIBONUCLEIC ACID (SIRNA) AGENTS****SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB****SPINAL MUSCULAR ATROPHY-ANTISENSE OLIGONUCLEOTIDES****SPINAL MUSCULAR ATROPHY-GENE THERAPY AGENTS****SPLEEN TYROSINE KINASE (SYK) INHIBITORS****STEROIDS - MOUTH/THROAT/DENTAL****SULFONAMIDES**SURGICAL SEALANTS****TETRACYCLINES**TETRAHYDROISOQUINOLINES****THICKENED PRODUCTS****THYROID AGENTS**TOPICAL ANESTHETIC GASES****TOXOIDS**TRANSCRANIAL MAGNETIC STIMULATORS****TRANSTHYRETIN STABILIZERS****TRIPEPTIDYL PEPTIDASE 1 DEFICIENCY TREATMENT - AGENTS****TRYPTOPHAN HYDROXYLASE INHIBITORS****ULCER DRUGS**URINARY ANALGESIC COMBINATIONS****URINARY ANTI-INFECTIVES**URINARY ANTISPASMODICS**VACCINES**VAGINAL PRODUCTS**VASOPRESSORS**VESICOURETERAL REFLUX (VUR) AGENT COMBINATIONS****VITAMINS A & C****VITAMINS A & D W/ K****VITAMINS A & D W/ MINERALS****VITAMINS**X-LINKED HYPOPHOSPHATEMIA (XLH) TREATMENT - AGENTS***
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Formulary Effective Date: 01/01/2020
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12/2019

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