Drug Search Main Content

Small Group Commercial 2020 Formulary

Note: This plan has limits on Opioid Medications. See page footer for details.

Alphabetical Search Skip to Brand & Generic Search

Brand & Generic Name Search


Therapeutic Class Search Skip to Footer

*Adhd/Anti-Narcolepsy/Anti-Obesity/Anorexiants**Aminoglycosides**Analgesics - Anti-Inflammatory**Analgesics - Nonnarcotic**Analgesics - Opioid**Androgens-Anabolic**Anorectal Agents**Antacids**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 Agents**Antimyasthenic/Cholinergic Agents**Antimycobacterial Agents**Antineoplastics And Adjunctive Therapies**Antiparkinson Agents**Antiparkinson And Related Therapy Agents**Antipsychotics/Antimanic Agents**Antiseptics & Disinfectants**Antivirals**Assorted Classes**Beta Blockers**Calcium Channel Blockers**Cardiotonics**Cardiovascular Agents - Misc.**Cephalosporins**Contraceptives**Corticosteroids**Cough/Cold/Allergy**Dermatologicals**Diagnostic Products**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**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**Oxytocics**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**Vitamins*
©1997-2020 Managed Markets Insight and Technology, LLC. All Rights Reserved | Terms of Use

NOTE: For members who renewed prior to 1/1/2020 coverage year please see chart below to determine the tiers and cost shares. Please reference your member materials for cost share details.

2019 Benefit Tier Copay/Cost share

2020 Tier Equivalent

Tier 1- Preventive

  • Preventive medications will now pay at $0 not subject to deductible when preventive criteria for medication is met. Medications may be listed on any tier on the formulary document.
  • Note: If preventive criteria for medication is not met it will pay at the designated formulary tier, subject to deductible if applicable.
  • PV= Preventive Medication 

Tier 2- Generic

  • Low Cost Generic
  • Tier 1- Generic 

Tier 3- Preferred

  • Tier 2- Preferred Brand 

Tier 4- Non-Preferred

  • Tier 3- Non-Preferred Brand 

Tier 5- High-Cost Specialty

  • Tier 4- Preferred Brand and Generic Specialty
  • Tier 5- Non-preferred Brand Specialty 


Opioid anti-tussive limits:

  • Liquids: Maximum of 240ML per fill.

  • Tablets/Capsules: Maximum 7-day supply per fill.

Short-acting Opioid (SAO) Limits:

  • New to therapy: Maximum of 49 MED and Maximum 7-day supply per fill.

  • Experience with therapy: Maximum of 90 MED.

Long-acting Opioid (LOA) Limits: PA required and Maximum of 90 MED.

Formulary Id: 00000000
Formulary Effective Date: 02/01/2020

Top of Page