Pharmacy Drug Formulary Lists

The following are lists of drug formularies that most employers and individuals may have with their health plan. To identify the drug formulary your plan has, please refer to your Summary of Benefits and Coverage page 3.

NOTE: The information provided is a general reference of our pharmacy benefits. Not all plans or members will use the same pharmacy programs. These references are not a guarantee of coverage. Benefit determinations are based on the member’s contractual agreement. Exclusions, limitations or exceptions may apply. Benefits vary based on contract, and individual member benefits must be verified.

Please refer to the Summary of Benefits and Coverage page 3 to identify the correct drug formulary with the plan.