Formulary
For-mu-lary: – A list of drugs covered by a plan.Drugs are added or removed from our Formulary during the year. Customers are notified at least 60 days before the effective change date. Check your Summary of Benefits for specific plan benefits and copay/coinsurance information.
Click on form name to access and download.
Click here to download the Comprehensive Formulary.
Click here to download the Prior Authorization Guidelines.
Click here to download the Step Therapy Guidelines.
Click here to download the Quantity Limits Outlines.
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updated 10/1/09
