2025 3-Tier State Mandate Formulary Guide (2950)
WELCOME
We cover both brand name and generic drugs. Generic drugs have the same active ingredient as brand name drugs but usually cost less and are considered by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
WHAT IS A FORMULARY?
A formulary is a list of drugs covered on a prescription drug plan. We carefully select prescription therapies believed to be a necessary part of a quality treatment program. A drug listed on our formulary is generally covered if the drug is used for a medically accepted use, the prescription is filled at a network pharmacy, and other plan rules are followed. Please see your plan documents for a complete description of your pharmacy benefit.
For a printable PDF of this formulary, click here (2025 3 Tier State Mandate)