Welcome to the Highmark Health Options Medicaid Formulary.
This formulary includes medications in the Delaware Medical Assistance Program (DMAP) Preferred Drug List (PDL) and medications which are not otherwise covered in the PDL.
You can search the formulary in several ways.
You can search the formulary alphabetically by selecting the first letter of the drug you are looking for, OR by either the Brand or Generic name of a drug by entering the name of the drug or the first few letters if the full name or correct spelling is not known.
You can also search the formulary by Therapeutic Class of the drug if the exact drug name is not known.
Some of the medications on the formulary require prior authorization, have a quantity limit, must be dispensed by a specialty pharmacy or require step therapy. These medications are marked with a symbol under the Notes & Restrictions column.
If your drug is not included in this formulary, you should first call member services at 1-844-325-6251
and ask if your drug is covered.
A physician may request a non-formulary medication only if medical necessity or failure of formulary alternatives are documented by the physician on the Health Options Medicaid Drug Exception Form.
Prescription coverage is dependent upon the drug manufacturer's participation in the Federal Medicaid Drug Rebate Program. Drugs marketed by a drug company that does not participate in the Federal Drug Rebate Program are excluded from coverage under the pharmacy benefit regardless of their formulary status or previous approval for medical necessity.