PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Update: July 1,

Size: px
Start display at page:

Download "PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Update: July 1,"

Transcription

1 Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details or ask Member Services if you have this benefit. How to use this list: Brand medicines are in ALL CAPS (e.g., DALIRESP ORAL TABLET) Generic medicines are in lower italics (e.g., furosemide oral tablet) Prior authorization Step therapy Quantity limit Age Edit Please note: If your drug requires,, or, you must meet the coverage criteria for the drug to be covered at your preventive benefit. Drug Alcohol Dependency Alcohol Dependency acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet Asthma & COPD Asthma & COPD, Other ATROVENT HFA INHALATION HFA ROSOL INHALER cromolyn inhalation solution for nebulization DALIRESP ORAL TABLET ipratropium bromide inhalation solution montelukast oral granules in packet montelukast oral tablet montelukast oral tablet,chewable Bronchodilators, Inhaled More Details INCRUSE ELLIPTA INHALATION BLIER WITH DEVICE 62.5 MCG/ACTUATION SEREVENT DISKUS INHALATION BLIER WITH DEVICE SPIRIVA RESPIMAT INHALATION MI SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE RIVERDI RESPIMAT INHALATION MI Bronchodilators, Oral Last Update: July 1,

2 theophylline oral tablet extended release theophylline oral tablet extended release 12 hr Combination Agents, Inhaled ADVAIR DISKUS INHALATION BLIER WITH DEVICE ADVAIR HFA INHALATION HFA ROSOL INHALER ANORO ELLIPTA INHALATION BLIER WITH DEVICE BREO ELLIPTA INHALATION BLIER WITH DEVICE COMBIVENT RESPIMAT INHALATION MI DULERA INHALATION HFA ROSOL INHALER fluticasone-salmeterol inhalation aerosol powdr breath activated ipratropium-albuterol inhalation solution for nebulization IOLTO RESPIMAT INHALATION MI Corticosteroids, Inhaled ARNUITY ELLIPTA INHALATION BLIER WITH DEVICE ASMANEX HFA INHALATION HFA ROSOL INHALER ASMANEX TWIHALER INHALATION ROSOL POWDR BREATH ACTIVATED 110 MCG (30 DOSES), 220 MCG (120 DOSES), 220 MCG (30 DOSES), 220 MCG (60 DOSES) budesonide inhalation suspension for nebulization FLOVENT DISKUS INHALATION BLIER WITH DEVICE FLOVENT HFA INHALATION HFA ROSOL INHALER ; PULMICORT FLEXHALER INHALATION ROSOL POWDR BREATH ACTIVATED QVAR INHALATION ROSOL Behavioral Health Antipsychotic aripiprazole oral solution aripiprazole oral tablet aripiprazole oral tablet,disintegrating chlorpromazine oral tablet clozapine oral tablet clozapine oral tablet,disintegrating fluphenazine hcl oral concentrate fluphenazine hcl oral elixir fluphenazine hcl oral tablet haloperidol lactate oral concentrate haloperidol oral tablet loxapine succinate oral capsule olanzapine oral tablet olanzapine oral tablet,disintegrating perphenazine oral tablet Last Update: July 1, ; ; ;

3 quetiapine oral tablet quetiapine oral tablet extended release 24 hr risperidone oral solution risperidone oral tablet risperidone oral tablet,disintegrating thioridazine oral tablet thiothixene oral capsule trifluoperazine oral tablet VERSACLOZ ORAL SUSPENSION ziprasidone hcl oral capsule Bipolar Disorder lithium carbonate oral capsule lithium carbonate oral tablet lithium carbonate oral tablet extended release lithium citrate oral solution 8 meq/5 ml Depression, Atypical Antidepressants bupropion hcl oral tablet bupropion hcl oral tablet extended release 12 hr bupropion hcl oral tablet extended release 24 hr mirtazapine oral tablet Depression, Maois phenelzine oral tablet tranylcypromine oral tablet Depression, Serotonin Modulators nefazodone oral tablet trazodone oral tablet Depression, Snris duloxetine oral capsule,delayed release(dr/ec) 20 mg, 30 mg, 60 mg venlafaxine oral capsule,extended release 24hr venlafaxine oral tablet Depression, Ssris citalopram oral solution citalopram oral tablet escitalopram oxalate oral solution escitalopram oxalate oral tablet fluoxetine oral capsule fluoxetine oral solution fluvoxamine oral tablet paroxetine hcl oral tablet XIL ORAL SUSPENSION ; ; ; Last Update: July 1,

4 sertraline oral concentrate sertraline oral tablet Depression, Tricyclic & Tetracyclic Antidepressants amitriptyline oral tablet 10 mg, 100 mg, 25 mg, 50 mg, 75 mg amitriptyline oral tablet 150 mg clomipramine oral capsule desipramine oral tablet doxepin oral capsule imipramine hcl oral tablet nortriptyline oral capsule nortriptyline oral solution Blood Thinner Anticoagulants ELIQUIS ORAL TABLET jantoven oral tablet PRADAXA ORAL CAPSULE warfarin oral tablet XARELTO ORAL TABLET XARELTO ORAL TABLETS,DOSE CK Platelet Inhibitors anagrelide oral capsule aspirin-dipyridamole oral capsule, er multiphase 12 hr BRILINTA ORAL TABLET cilostazol oral tablet clopidogrel oral tablet 75 mg dipyridamole oral tablet EFFIENT ORAL TABLET ZONTIVITY ORAL TABLET Cancer Cancer, Serms tamoxifen oral tablet Diabetes Diabetes, Alpha-Glucosidase Inhibitors acarbose oral tablet miglitol oral tablet Diabetes, Biguanides metformin oral tablet metformin oral tablet extended release 24 hr Diabetes, Dpp-4 Inhibitor / Biguanide Combinations JENTADUETO ORAL TABLET Last Update: July 1,

5 JENTADUETO XR ORAL TABLET, IR - ER, BIPHASIC 24HR 2.5-1,000 MG Diabetes, Dpp-4 Inhibitors TRADJENTA ORAL TABLET Diabetes, Glp-1 Agonists BYDUREON SUBCUTANEOUS PEN INJECTOR BYDUREON SUBCUTANEOUS SUSPENSION,EXTENDED REL RECON BYETTA SUBCUTANEOUS PEN INJECTOR 10 MCG/DOSE(250 MCG/ML) 2.4 ML, 5 MCG/DOSE (250 MCG/ML) 1.2 ML TRULICITY SUBCUTANEOUS PEN INJECTOR VICTOZA 2-K SUBCUTANEOUS PEN INJECTOR VICTOZA 3-K SUBCUTANEOUS PEN INJECTOR Diabetes, Intermediate-Acting Insulins HUMULIN N KWIKPEN SUBCUTANEOUS INSULIN PEN HUMULIN N SUBCUTANEOUS SUSPENSION Diabetes, Long-Acting Insulins BASAGLAR KWIKPEN SUBCUTANEOUS INSULIN PEN LEVEMIR FLEXTOUCH SUBCUTANEOUS INSULIN PEN LEVEMIR SUBCUTANEOUS SOLUTION Diabetes, Meglitinides nateglinide oral tablet repaglinide oral tablet Diabetes, Other Oral Agents CYCLOSET ORAL TABLET Diabetes, Pre-Mixed Insulins HUMALOG MIX KWIKPEN SUBCUTANEOUS INSULIN PEN HUMALOG MIX SUBCUTANEOUS SUSPENSION HUMALOG MIX KWIKPEN SUBCUTANEOUS INSULIN PEN HUMALOG MIX SUBCUTANEOUS SUSPENSION HUMULIN 70/30 KWIKPEN SUBCUTANEOUS INSULIN PEN HUMULIN 70/30 SUBCUTANEOUS SUSPENSION Diabetes, Rapid-Acting Insulins HUMALOG KWIKPEN SUBCUTANEOUS INSULIN PEN HUMALOG SUBCUTANEOUS CARTRIDGE HUMALOG SUBCUTANEOUS SOLUTION Diabetes, Rescue Agents GLUCAGEN HYPOKIT INJECTION RECON SOLN GLUCAGEN INJECTION RECON SOLN GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT Diabetes, Sglt2 Inhibitor / Biguanide Combinations INVOKAMET ORAL TABLET Last Update: July 1,

6 INVOKAMET XR ORAL TABLET, IR - ER, BIPHASIC 24HR SYNJARDY ORAL TABLET SYNJARDY XR ORAL TABLET, IR - ER, BIPHASIC 24HR Diabetes, Sglt2 Inhibitors INVOKANA ORAL TABLET JARDIANCE ORAL TABLET Diabetes, Short-Acting Insulins HUMULIN R U-100 INJECTION SOLUTION HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN HUMULIN R U-500 (CONCENTRATED) SUBCUTANEOUS SOLUTION Diabetes, Sulfonylurea / Biguanide Combination glipizide-metformin oral tablet Diabetes, Sulfonylureas glimepiride oral tablet glipizide oral tablet glipizide oral tablet extended release 24hr Diabetes, Thiazolidinedione / Biguanide Combinations pioglitazone-metformin oral tablet Diabetes, Thiazolidinedione / Sulfonylurea Combinations pioglitazone-glimepiride oral tablet Diabetes, Thiazolidinediones pioglitazone oral tablet Heart Health Blood Pressure, ACEI & ARB amlodipine-benazepril oral capsule amlodipine-valsartan oral tablet amlodipine-valsartan-hcthiazid oral tablet benazepril oral tablet benazepril-hydrochlorothiazide oral tablet captopril oral tablet captopril-hydrochlorothiazide oral tablet enalapril maleate oral tablet enalapril-hydrochlorothiazide oral tablet fosinopril oral tablet fosinopril-hydrochlorothiazide oral tablet irbesartan oral tablet irbesartan-hydrochlorothiazide oral tablet lisinopril oral tablet lisinopril-hydrochlorothiazide oral tablet losartan oral tablet Last Update: July 1,

7 losartan-hydrochlorothiazide oral tablet moexipril oral tablet moexipril-hydrochlorothiazide oral tablet mg, mg moexipril-hydrochlorothiazide oral tablet mg perindopril erbumine oral tablet quinapril oral tablet quinapril-hydrochlorothiazide oral tablet ramipril oral capsule trandolapril oral tablet valsartan oral tablet valsartan-hydrochlorothiazide oral tablet Blood Pressure, Beta Blockers atenolol oral tablet atenolol-chlorthalidone oral tablet bisoprolol fumarate oral tablet bisoprolol-hydrochlorothiazide oral tablet carvedilol oral tablet COREG CR ORAL CAPSULE, ER MULTIPHASE 24 HR labetalol oral tablet metoprolol succinate oral tablet extended release 24 hr metoprolol ta-hydrochlorothiaz oral tablet metoprolol tartrate oral tablet 100 mg, 25 mg, 50 mg nadolol oral tablet propranolol oral capsule,extended release 24 hr propranolol oral tablet propranolol-hydrochlorothiazid oral tablet Blood Pressure, Calcium Channel Blockers amlodipine oral tablet amlodipine-benazepril oral capsule amlodipine-valsartan oral tablet amlodipine-valsartan-hcthiazid oral tablet cartia xt oral capsule,extended release 24hr diltiazem hcl oral capsule, extended release diltiazem hcl oral capsule,ext release degradable diltiazem hcl oral capsule,extended release 12 hr diltiazem hcl oral capsule,extended release 24hr diltiazem hcl oral tablet dilt-xr oral capsule,ext release degradable 120 mg, 180 mg nifedipine oral tablet extended release nifedipine oral tablet extended release 24hr Last Update: July 1,

8 taztia xt oral capsule, extended release 120 mg, 180 mg, 300 mg verapamil oral capsule,ext rel. pellets 24 hr verapamil oral tablet verapamil oral tablet extended release Blood Pressure, Other clonidine hcl oral tablet clonidine transdermal patch weekly doxazosin oral tablet guanfacine oral tablet hydralazine oral tablet methyldopa oral tablet minoxidil oral tablet prazosin oral capsule reserpine oral tablet terazosin oral capsule Cholesterol Lowering, Bile Acid Resins cholestyramine (with sugar) oral powder cholestyramine (with sugar) oral powder in packet cholestyramine light oral powder cholestyramine light oral powder in packet colestipol oral tablet Cholesterol Lowering, Other ezetimibe oral tablet Cholesterol Lowering, Statins atorvastatin oral tablet 10 mg, 20 mg atorvastatin oral tablet 40 mg, 80 mg lovastatin oral tablet 10 mg lovastatin oral tablet 20 mg, 40 mg pravastatin oral tablet rosuvastatin oral tablet 10 mg, 5 mg rosuvastatin oral tablet 20 mg, 40 mg simvastatin oral tablet 10 mg, 20 mg simvastatin oral tablet 40 mg simvastatin oral tablet 5 mg simvastatin oral tablet 80 mg Diuretics amiloride oral tablet amiloride-hydrochlorothiazide oral tablet bumetanide oral tablet chlorothiazide oral tablet Last Update: July 1,

9 chlorthalidone oral tablet 25 mg, 50 mg eplerenone oral tablet furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) furosemide oral tablet hydrochlorothiazide oral capsule hydrochlorothiazide oral tablet indapamide oral tablet metolazone oral tablet spironolactone oral tablet spironolacton-hydrochlorothiaz oral tablet torsemide oral tablet triamterene-hydrochlorothiazid oral capsule triamterene-hydrochlorothiazid oral tablet Heart Health, Other ENTREO ORAL TABLET Triglyceride Lowering fenofibrate micronized oral capsule 134 mg, 200 mg, 67 mg fenofibrate nanocrystallized oral tablet fenofibrate oral tablet 160 mg, 54 mg gemfibrozil oral tablet omega-3 acid ethyl esters oral capsule VASCE ORAL CAPSULE Smoking Cessation Nicotine Replacement nicotine (polacrilex) buccal gum nicotine (polacrilex) buccal lozenge nicotine transdermal patch 24 hour NICOTROL INHALATION CARTRIDGE NICOTROL NS NASAL SPRAY,NON-ROSOL Smoking Cessation, Other buproban oral tablet extended release 12 hr CHANTIX ORAL TABLET CHANTIX ARTING MONTH BOX ORAL TABLETS,DOSE CK Vitamins And Minerals Vitamins And Minerals completenate oral tablet,chewable inatal ultra oral tablet mynatal plus oral tablet mynate 90 plus oral tablet extended release o-cal prenatal oral tablet Last Update: July 1,

10 prenaplus oral tablet prenatabs fa oral tablet prenatabs rx oral tablet prenatal low iron oral tablet prenatal plus (calcium carb) oral tablet prenatal plus oral tablet trinate oral tablet vinate care oral tablet,chewable vinate one oral tablet Weight Loss Weight Loss ALLI ORAL CAPSULE phentermine oral capsule 15 mg, 30 mg, 37.5 mg phentermine oral tablet XENICAL ORAL CAPSULE Last Update: July 1,

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. Last Updated: January 1,

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. Last Updated: January 1, Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Updated: April 1,

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Updated: April 1, Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

Preventive Drug List. More Details. Alcohol Dependency Alcohol Dependency acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet

Preventive Drug List. More Details. Alcohol Dependency Alcohol Dependency acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

Antibiotic Treatments. Arthritis & Pain. Asthma. Cholesterol

Antibiotic Treatments. Arthritis & Pain. Asthma. Cholesterol MAX Saver Plan Drug List 08/06/14 GENERIC NAME Allergies and Cold & Flu BENZONATATE CAP 100 MG 14 42 cap CETIRIZINE HCL TAB 10MG 30 90 tab CETIRIZINE HCL TAB 5MG 30 90 tab DIPHENHYDRAMINE HCL CAP 50 MG

More information

Acyclovir Ointment. Aetna Better Health Kentucky. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health Kentucky. Products Affected. acyclovir ointment 5 % external Details. Criteria Acyclovir Ointment acyclovir ointment 5 % external Aetna Better Health Kentucky Use of oral acyclovir or Abreva in the previous 130 days 1 Adcirca ADCIRCA TABLET 20 MG ORAL Use of sildenafil in previous

More information

Acyclovir Ointment. Aetna Better Health Virginia Medallion/FAMIS 3.0. Products Affected. acyclovir ointment 5 % external Details.

Acyclovir Ointment. Aetna Better Health Virginia Medallion/FAMIS 3.0. Products Affected. acyclovir ointment 5 % external Details. Aetna Better Health Virginia Medallion/FAMIS 3.0 Acyclovir Ointment acyclovir ointment 5 % external Use of oral acyclovir in the previous 130 days 1 Adcirca tadalafil (pah) tablet 20 mg oral Use of sildenafil

More information

Acyclovir Ointment. Aetna Better Health New Jersey. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health New Jersey. Products Affected. acyclovir ointment 5 % external Details. Criteria Acyclovir Ointment acyclovir ointment 5 % external Aetna Better Health New Jersey Use of oral acyclovir or Abreva in the previous 130 days 1 Adcirca tadalafil (pah) tablet 20 mg oral Use of sildenafil

More information

Step Therapy Criteria Last Updated 6/1/2018

Step Therapy Criteria Last Updated 6/1/2018 Step Therapy Last Updated 6/1/2018 For information on obtaining an updated coverage determination or an exception to a coverage determination please call Freedom Health Member Services at 1-800-401-2740

More information

ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS

ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE What screening should be done? NCQA

More information

Allergies and Cold & Flu

Allergies and Cold & Flu MAX Saver Plan Drug List 01/23/17 GENERIC NAME Allergies and Cold & Flu BENZONATATE CAP 100 MG 14 42 cap CETIRIZINE HCL TAB 10MG 30 90 tab CETIRIZINE HCL TAB 5MG 30 90 tab DIPHENHYDRAMINE HCL CAP 50 MG

More information

New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective

New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective Generic_Name Current NJ SUL New NJ SUL Proposed ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-30MG 0.12455 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-60MG 0.25688 ALBUTEROL SULFATE

More information

2018 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Ohana Community Care Services (CCS) Comprehensive referred Drug List (List of Covered Drugs) Ohana Health lan 00 lease read: This document contains information about the drugs we cover in this plan.

More information

2019 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs)

2019 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs) 2019 Ohana Community Care Services (CCS) Comprehensive referred Drug List (List of Covered Drugs) Ohana Health lan 00 lease read: This document contains information about the drugs we cover in this plan.

More information

WELLCARE HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 10/2014)

WELLCARE HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 10/2014) WELLCARE HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 10/2014) **To get updated information about the drugs covered by WellCare, please visit our website (https://www.wellcare.com) or

More information

Acyclovir Ointment. Aetna Better Health Louisiana. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health Louisiana. Products Affected. acyclovir ointment 5 % external Details. Criteria Acyclovir Ointment acyclovir ointment 5 % external Aetna Better Health Louisiana Use of oral acyclovir in the previous 130 days 1 Adcirca ADCIRCA TABLET 20 MG ORAL Use of sildenafil in previous 30 days

More information

6.25 mg 1 tab, PO, BIDMEALS, Take with Meals, Duration: 30 day (DEF)*

6.25 mg 1 tab, PO, BIDMEALS, Take with Meals, Duration: 30 day (DEF)* DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Medications Antiarrhythmics amiodarone 200 mg oral tablet (Rx)* 200 mg 2 tab, PO, BID, Duration: 30 day (DEF)* 200 mg 2 tab, PO, BID, Duration:

More information

PREFERRED DRUG LIST 2018

PREFERRED DRUG LIST 2018 PREFERRED DRUG LIST 2018 PDL National Formulary Preferred Drug List - May 2018 - The Preferred Drug List is a guide identifying preferred brandname medicines within select therapeutic categories. The Preferred

More information

PHP Commercial Large Group Plans (Non-Metal Plans) Formulary Therapeutic Class Listing

PHP Commercial Large Group Plans (Non-Metal Plans) Formulary Therapeutic Class Listing Presbyterian Health Plan Presbyterian Insurance Company, Inc. PHP Commercial Large Group Plans (Non-Metal Plans) Formulary Therapeutic Class Listing This list is in order by therapeutic class. To find

More information

HealthPartners Compass $2850 HSA (Silver) 2016 Formulary. (List of covered drugs)

HealthPartners Compass $2850 HSA (Silver) 2016 Formulary. (List of covered drugs) HealthPartners Compass $2850 HSA (Silver) 2016 Formulary (List of covered drugs) For current information on the GenericsAdvantageRx Drug List, visit healthpartners.com/pharmacy. Effective: October 1, 2016

More information

Membership Clinic 2015

Membership Clinic 2015 Membership Clinic 2015 ISD 15 has asked NeoPath to evaluate different options for how we can improve clinic accessibility, enhance the patient experience, boost utilization of the ISD 15 clinic and maintain

More information

2016 Provider Directory. Drug Formulary

2016 Provider Directory. Drug Formulary 2016 Provider Directory Drug Formulary lowercase italics= Generic drugs UPPERCASE BOLD= Brand name drugs Drug Tier Notes Antihistamine Drugs Ethanolamine Derivatives clemastine oral tablet diphenhydramine

More information

HealthPartners PreferredRx

HealthPartners PreferredRx HealthPartners PreferredRx 2018 Formulary (List of covered drugs) For current information on the PreferredRx Drug List, visit healthpartners.com/pharmacy. Effective: October 1, 2018 2018 HealthPartners

More information

HealthPartners Minnesota Health Care Programs

HealthPartners Minnesota Health Care Programs HealthPartners Minnesota Health Care Programs 2018 Formulary (List of covered drugs) For current information on the Minnesota Health Care Programs Drug List, visit healthpartners.com/pharmacy. Effective:

More information

HealthPartners GenericsPlusRx

HealthPartners GenericsPlusRx HealthPartners GenericsPlusRx 2018 Formulary (List of covered drugs) For current information on the GenericsPlusRx Drug List, visit healthpartners.com/pharmacy. Effective: October 1, 2018 2018 HealthPartners

More information

Preferred Drug List. Select Health PerformRx Pharmacy Services Phone Fax

Preferred Drug List. Select Health PerformRx Pharmacy Services Phone Fax Preferred Drug List Select Health PerformRx Pharmacy Services Phone 1.866.610.2773 Fax 1.866.610.2775 Member Services Phone 1.888.276.2020 Providers may request the addition or deletion of a medication

More information

New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective

New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective New Jersey Department of Human Services State Upper Limit () List - PROPOSED Effective 07-01-2018 New ABACAVIR FATE ORAL TABLET 300 MG ABACAVIR FATE/LAMIVUDINE ORAL TABLET 600-300MG ABACAVIR FATE/LAMIVUDINE/ZIDOVUDINE

More information

healthpartners.com/pharmacy.

healthpartners.com/pharmacy. HealthPartners Empower HSA NationalONE Embedded Silver 4000-100 Rx Plus HealthPartners Empower HSA NationalONE Embedded Silver 3000-80 Rx Plus 2017 Formulary (List of covered drugs) For current information

More information

4-TIER HIGH DEDUCTIBLE HEALTH PLAN FORMULARY Effective May 2018

4-TIER HIGH DEDUCTIBLE HEALTH PLAN FORMULARY Effective May 2018 4-TIER HIGH DEDUCTIBLE HEALTH PLAN FORMULARY Effective May 2018 Provided by EnvisionRx Introduction The Total Health Care (THC) 4-Tier High Deductible Health Plan Formulary was developed to serve as a

More information

healthpartners.com/pharmacy.

healthpartners.com/pharmacy. 4 Tier 2018 Formulary (List of covered drugs) For current information on the GenericsAdvantageRx Drug List, visit healthpartners.com/pharmacy. Effective: April 1, 2018 2018 HealthPartners What s the GenericsAdvantageRx

More information

2017 Drug List for Qualified Health Plans

2017 Drug List for Qualified Health Plans 207 Drug List for Qualified Health Plans HAP Personal Alliance and small group Use this drug list also known as a formulary to learn about the prescription drugs we cover in all qualified health plans.

More information

PHP Centennial Care Formulary/Preferred Drug Listing

PHP Centennial Care Formulary/Preferred Drug Listing PHP Centennial Care Formulary/Preferred Drug Listing The Centennial Care Preferred Drug List is subject to change. Presbyterian Centennial Care This list is in order by therapeutic class. To find a specific

More information

Medicaid Drug Formulary January 2019

Medicaid Drug Formulary January 2019 Medicaid Drug Formulary January 2019 Key * Generic Available AG Age Limits F Females Only M Males Only OTC Over the Counter P Preventive PA Prior Authorization QL Quantity Limit SP Specialty Pharmacy ST

More information

3 Tier Formulary (List of Covered Drugs)

3 Tier Formulary (List of Covered Drugs) Effective: August 1, 2016 Large Group Non-Qualified Health Plans Small Group Non-Qualified Health Plans 3 Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors

More information

Commercial Metal 5-Tier Formulary (List of Covered Drugs)

Commercial Metal 5-Tier Formulary (List of Covered Drugs) Updated: September 1, 2018 Small Group Metal Plans Individual Metal Plans Commercial Metal 5-Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors and pharmacists,

More information

Commercial Metal 5-Tier Formulary (List of Covered Drugs)

Commercial Metal 5-Tier Formulary (List of Covered Drugs) Updated: January 1, 2019 Small Group Metal Plans Individual Metal Plans Commercial Metal 5-Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors and pharmacists,

More information

3-TIER FORMULARY Effective November 2017

3-TIER FORMULARY Effective November 2017 3-TIER FORMULARY Effective November 2017 Provided by EnvisionRx Introduction The Total Health Care (THC) 3-Tier Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals

More information

OPTIMA HEALTH OPTIMA FAMILY CARE (JANUARY MARCH 2019) PRESCRIPTION DRUG FORMULARY WITH MEDICAID EXPANSION (XP) Effective: January 1, 2019

OPTIMA HEALTH OPTIMA FAMILY CARE (JANUARY MARCH 2019) PRESCRIPTION DRUG FORMULARY WITH MEDICAID EXPANSION (XP) Effective: January 1, 2019 OPTIMA HEALTH PRESCRIPTION DRUG FORMULARY OPTIMA FAMILY CARE WITH MEDICAID EXPANSION (XP) (JANUARY MARCH 2019) Revised: 1/2/2019 Table of Contents Analgesics - Drugs for Pain... 3 Analgesics - Drugs for

More information

Qualified Health Plans 2018 Drug Formulary for HMOs and PPOs

Qualified Health Plans 2018 Drug Formulary for HMOs and PPOs Qualified Health Plans 2018 Drug Formulary for HMOs and PPOs THIS DOCUMENT HAS INFORMATION ABOUT THE PRESCRIPTION DRUGS WE COVER FOR QUALIFIED HEALTH PLANS. Qualified Health Plans (QHP) are Affordable

More information

2018 Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Comprehensive referred Drug List (List of Covered Drugs) WellCare of Georgia lanning for Healthy Babies: Interpregnancy Care lease read: This document tells about the drugs we cover in this plan.

More information

2018 Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Comprehensive referred Drug List (List of Covered Drugs) WellCare of Georgia lanning for Healthy Babies: Interpregnancy Care lease read: This document tells about the we cover in this plan. If you

More information

HealthPartners PreferredRx

HealthPartners PreferredRx HealthPartners PreferredRx Drug List (formulary) For current information on the PreferredRx Drug List, visit healthpartners.com/pharmacy. Effective: April 1, 2014 2013 HealthPartners What s the PreferredRx

More information

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. HealthPartners Freedom Group (Cost) HealthPartners Journey Group (PPO) HealthPartners Retiree National Choice (PDP) (Collectively known as HealthPartners) 019 Formulary II (List of Covered Drugs) PLEASE

More information

Commercial Metal 5-Tier Formulary (List of Covered Drugs)

Commercial Metal 5-Tier Formulary (List of Covered Drugs) Updated: September 15, 2017 Small Group Metal Plans Individual Metal Plans Commercial Metal 5-Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors and pharmacists,

More information

2018 Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Comprehensive referred Drug List (List of Covered Drugs) Care1st Health lan Arizona Family lanning lease read: This document contains information about the drugs we cover in this plan. lease note

More information

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Kentucky Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of Kentucky lease read: This document contains information about the drugs we cover in this plan. lease note that

More information

2019 Commercial 5-Tier Formulary (List of Covered Drugs) What is the Drug List?

2019 Commercial 5-Tier Formulary (List of Covered Drugs) What is the Drug List? Effective: January 1, 2019 Large and Small Group Health Plans Individual Health Plans Third Party Administered Health Plans 2019 Commercial 5-Tier Formulary (List of Covered Drugs) What is the Drug List?

More information

Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2017 Harmony Medicaid Comprehensive referred Drug List (List of Covered Drugs) Harmony Health lan lease read: This document contains information about the drugs we cover in this plan. lease note that the

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2018

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2018 AETNA BETTER HEALTH Formulary Guide 2018 Aetna Better Health Pennsylvania Formulary Guide April 2018 AETNA BETTER HEALTH Formulary Guide 2018 What is the Aetna Better Health in Pennsylvania Formulary?

More information

New York Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

New York Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 New York Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare Health lans, Inc. 00 lease read: This document has information about drugs we cover in this plan. lease note that

More information

MEDICAID FORMULARY Effective November 2017

MEDICAID FORMULARY Effective November 2017 MEDICAID FORMULARY Effective November 2017 Provided by EnvisionRx Introduction The Total Health Care (THC) Medicaid Formulary was developed to serve as a guide for physicians, pharmacists, health care

More information

2018 South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 South Carolina Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of South Carolina lease read: This document contains information about the drugs we cover in this plan. lease

More information

2018 Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Harmony Medicaid Comprehensive referred Drug List (List of Covered Drugs) Harmony Health lan lease read: This document contains information about the drugs we cover in this plan. lease note that the

More information

South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 South Carolina Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of South Carolina 00 lease read: This document contains information about the drugs we cover in this plan.

More information

2018 Commercial 3-Tier Formulary (List of Covered Drugs)

2018 Commercial 3-Tier Formulary (List of Covered Drugs) Effective: July 1, 2018 Large Group Health Plans Small Group Health Plans 2018 Commercial 3-Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors and pharmacists,

More information

Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Harmony Medicaid Comprehensive referred Drug List (List of Covered Drugs) Harmony Health lan lease read: This document contains information about the drugs we cover in this plan. lease note that the

More information

2017 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs)

2017 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs) 2017 Ohana Medicaid Comprehensive referred Drug List (QUEST Integration) (List of Covered Drugs) Ohana Health lan 00 lease read this document. It has details about the drugs we cover for the Ohana QUEST

More information

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Kentucky Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of Kentucky lease read: This document contains information about the drugs we cover in this plan. lease note that

More information

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Kentucky Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of Kentucky 00 lease read: This document contains information about the drugs we cover in this plan. lease note

More information

2018 Georgia Families Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Georgia Families Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Georgia Families Comprehensive referred Drug List (List of Covered Drugs) WellCare of Georgia, Inc. lease read: This document tells about the drugs we cover in this plan. If you speak a different

More information

Memorial Hermann Advantage HMO & PPO April 2018 Formulary Addendum

Memorial Hermann Advantage HMO & PPO April 2018 Formulary Addendum Memorial Hermann Advantage HMO & PPO April 2018 Formulary Addendum Changes may have occurred since the printing of your current Memorial Hermann Advantage HMO & PPO Formulary. Medications that may have

More information

COMMERCIAL FORMULARY Effective April 2018

COMMERCIAL FORMULARY Effective April 2018 COMMERCIAL FORMULARY Effective April 2018 Provided by EnvisionRx Introduction The Total Health Care (THC) Commercial Formulary was developed to serve as a guide for physicians, pharmacists, health care

More information

COMMERCIAL FORMULARY Effective November 2017

COMMERCIAL FORMULARY Effective November 2017 COMMERCIAL FORMULARY Effective November 2017 Provided by EnvisionRx Introduction The Total Health Care (THC) Commercial Formulary was developed to serve as a guide for physicians, pharmacists, health care

More information

New York Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

New York Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2017 New York Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare Health lans, Inc. 00 lease read: This document has information about drugs we cover in this plan. lease note that

More information

2018 Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Harmony Medicaid Comprehensive referred Drug List (List of Covered Drugs) Harmony Health lan lease read: This document contains information about the drugs we cover in this plan. lease note that the

More information

Comprehensive Preferred Drug List (List of Covered Drugs)

Comprehensive Preferred Drug List (List of Covered Drugs) 2017 Comprehensive referred Drug List (List of Covered Drugs) WellCare of Georgia lanning for Healthy Babies: Interpregnancy Care lease read: This document tells about the drugs we cover in this plan.

More information

Health First Health Plans 2018 Formulary (List of Covered Drugs)

Health First Health Plans 2018 Formulary (List of Covered Drugs) Updated: July 1, 2018 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Employer Group Plus A Plan (HMO) Employer Group Plus B Plan (HMO) Employer Group POS Plan (HMO-POS) Health First Health

More information

Georgia Families Comprehensive Preferred Drug List (List of Covered Drugs)

Georgia Families Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Georgia Families Comprehensive referred Drug List (List of Covered Drugs) WellCare of Georgia, Inc. 00 9 lease read: This document tells about the drugs we cover in this plan. If you speak a different

More information

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Kentucky Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Kentucky Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of Kentucky lease read: This document contains information about the drugs we cover in this plan. lease note that

More information

2018 Care1st Health Plan Arizona Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Care1st Health Plan Arizona Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Care1st Health lan Arizona Medicaid Comprehensive referred Drug List (List of Covered Drugs) Care1st Health lan Arizona lease read: This document contains information about the we cover in this plan.

More information

2018 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs)

2018 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs) 2018 Ohana Medicaid Comprehensive referred Drug List (QUEST Integration) (List of Covered Drugs) Ohana Health lan 00 lease read this document. It has details about the drugs we cover for the Ohana QUEST

More information

2018 Presbyterian Individual and Family Metal Plans/Employer Group Metal Plans Formulary Therapeutic Class Listing

2018 Presbyterian Individual and Family Metal Plans/Employer Group Metal Plans Formulary Therapeutic Class Listing Presbyterian Health Plan, Inc. Presbyterian Insurance Company, Inc. 018 Presbyterian Individual and Family Metal Plans/Employer Group Metal Plans Formulary Therapeutic Class Listing This list in order

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide May 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide May 2017 AETNA BETTER HEALTH Formulary Guide 2017 Aetna Better Health Pennsylvania Formulary Guide May 2017 AETNA BETTER HEALTH Formulary Guide 2017 What is the Aetna Better Health in Pennsylvania Formulary? This

More information

2018 Florida Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Florida Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Florida Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of Florida lease read: This document contains information about the drugs we cover in this plan. lease note that

More information

2017 Drug List for Commercial Health Plans

2017 Drug List for Commercial Health Plans 2017 Drug List for Commercial Health Plans Use this drug list also known as a formulary to learn about the prescription drugs we cover in all commercial health plans. Commercial health plans are a type

More information

2018 List of Covered Drugs (Formulary)

2018 List of Covered Drugs (Formulary) 208 List of Covered Drugs (Formulary) UCare s MSHO and UCare Connect + Medicare This is a list of drugs that members can get in UCare s MSHO and UCare Connect + Medicare. UCare s MSHO and UCare Connect

More information

Signature Advantage (HMO SNP) 2018 Comprehensive Formulary. List of Covered Drugs

Signature Advantage (HMO SNP) 2018 Comprehensive Formulary. List of Covered Drugs Signature Advantage (HMO SNP) 208 Comprehensive Formulary List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission

More information

Health First Health Plans 2019 Formulary (List of Covered Drugs)

Health First Health Plans 2019 Formulary (List of Covered Drugs) Updated: 10/2018 Health First Health Plans 2019 Formulary (List of Covered Drugs) Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Employer Group Plus A Plan (HMO) Employer Group Plus B Plan

More information

2018 New Jersey Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 New Jersey Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 New Jersey Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of New Jersey 00 lease read: This document contains information about the drugs we cover in this plan. lease note

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2019

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2019 AETNA BETTER HEALTH Formulary Guide 2019 Aetna Better Health Pennsylvania Formulary Guide April 2019 AETNA BETTER HEALTH Formulary Guide 2019 What is the Aetna Better Health in Pennsylvania Formulary?

More information

Comprehensive Drug List (List of Covered Drugs)

Comprehensive Drug List (List of Covered Drugs) 2017 Comprehensive Drug List (List of Covered Drugs) WellCare of Nebraska- Family lanning 00 lease read: This document contains information about the drugs we cover in this plan. lease note that the Nebraska

More information

New York Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

New York Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2017 New York Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare Health lans, Inc. 00 lease read: This document has information about drugs we cover in this plan. lease note that

More information

2016 COMPREHENSIVE FORMULARY

2016 COMPREHENSIVE FORMULARY 016 COMPREHENSIVE FORMULARY (LIST OF COVERED DRUGS) PRESCRIPTION DRUG PLANS Please Read: This document contains information about some of the drugs we cover in this plan. This formulary was updated on

More information

2017 Presbyterian Individual and Family Metal Plans/Employer Group Metal Plans Formulary Therapeutic Class Listing

2017 Presbyterian Individual and Family Metal Plans/Employer Group Metal Plans Formulary Therapeutic Class Listing Presbyterian Health Plan, Inc. Presbyterian Insurance Company, Inc. 207 Presbyterian Individual and Family Metal Plans/Employer Group Metal Plans Formulary Therapeutic Class Listing This list in order

More information

2018 Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Harmony Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Harmony Medicaid Comprehensive referred Drug List (List of Covered Drugs) Harmony Health lan lease read: This document contains information about the drugs we cover in this plan. lease note that the

More information

South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2017 South Carolina Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of South Carolina 00 lease read: This document contains information about the drugs we cover in this plan.

More information

2018 Formulary (List of Covered Drugs) UCare for Seniors Prime (HMO-POS) UCare for Seniors Standard (HMO-POS)

2018 Formulary (List of Covered Drugs) UCare for Seniors Prime (HMO-POS) UCare for Seniors Standard (HMO-POS) 208 Formulary (List of Covered Drugs) UCare for Seniors Prime (HMO-POS) UCare for Seniors Standard (HMO-POS) This formulary was updated on 05/0/208. For more recent information or other questions, please

More information

2018 South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 South Carolina Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 South Carolina Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of South Carolina lease read: This document contains information about the drugs we cover in this plan. lease

More information

Updated: November 1, 2017 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Health First Health Plans 2017 Formulary (List of Covered Drugs)

Updated: November 1, 2017 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Health First Health Plans 2017 Formulary (List of Covered Drugs) Updated: November 1, 2017 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Health First Health Plans 2017 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT

More information

2018 Florida Medicaid Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Florida Medicaid Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Florida Medicaid Comprehensive referred Drug List (List of Covered Drugs) WellCare of Florida 00 lease read: This document contains information about the drugs we cover in this plan. lease note that

More information

AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of Michigan Formulary Guide August 2017

AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of Michigan Formulary Guide August 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Michigan Formulary Guide August 2017 AETNA BETTER HEALTH Formulary Guide http://www.aetnabetterhealth.com/michigan What is the Aetna Better Health

More information

AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of Michigan Formulary Guide September 2018

AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of Michigan Formulary Guide September 2018 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Michigan Formulary Guide September 2018 AETNA BETTER HEALTH Formulary Guide http://www.aetnabetterhealth.com/michigan What is the Aetna Better

More information

Health First Health Plans 2019 Formulary (List of Covered Drugs)

Health First Health Plans 2019 Formulary (List of Covered Drugs) Updated: March 1, 2019 Health First Health Plans 2019 Formulary (List of Covered Drugs) SunSaver (HMO) Employer Group Plus C Plan (HMO) Employer Group Plus D Plan (HMO) Employer Group POS B Plan (HMO-POS)

More information

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. HealthPartners UnityPoint Health Align (PPO) HealthPartners UnityPoint Health Symmetry (PPO) (Collectively known as HealthPartners UnityPoint Health) 017 Formulary (List of Covered Drugs) PLEASE READ:

More information

2018 Comprehensive Drug List (List of Covered Drugs)

2018 Comprehensive Drug List (List of Covered Drugs) 2018 Comprehensive Drug List (List of Covered Drugs) WellCare of Nebraska Children s Health Insurance lan (CHI) lease read: This document contains information about the drugs we cover in this plan. lease

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide October 2018

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide October 2018 AETNA BETTER HEALTH Formulary Guide 2018 Aetna Better Health Pennsylvania Formulary Guide October 2018 AETNA BETTER HEALTH Formulary Guide 2018 What is the Aetna Better Health in Pennsylvania Formulary?

More information

Memorial Hermann Advantage HMO & PPO Abridged Formulary. (Partial List of Covered Drugs)

Memorial Hermann Advantage HMO & PPO Abridged Formulary. (Partial List of Covered Drugs) Memorial Hermann Advantage H & PPO 2017 Abridged Formulary (Partial List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary

More information

AULTCARE Formulary

AULTCARE Formulary 2019 Formulary AultCare's formulary is designed to provide value. Only speci ic drugs in each therapeutic class are covered. The formulary design provides adequate options in each therapeut c category

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide March 2019

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide March 2019 AETNA BETTER HEALTH Formulary Guide 2019 Aetna Better Health Pennsylvania Formulary Guide March 2019 AETNA BETTER HEALTH Formulary Guide 2019 What is the Aetna Better Health in Pennsylvania Formulary?

More information

2018 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs)

2018 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs) 2018 Ohana Medicaid Comprehensive referred Drug List (QUEST Integration) (List of Covered Drugs) Ohana Health lan 00 lease read this document. It has details about the drugs we cover for the Ohana QUEST

More information

Your Guide to Prescription Drug Benefits

Your Guide to Prescription Drug Benefits Your Guide to Prescription Drug Benefits 2018 ESSENTIAL FORMULARY GUIDE FOR INDIVIDUAL AND SMALL GROUP* PLANS *Does not apply to the following Small Group plans. For these plans, please refer to the 2018

More information