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Plan Formularies

If a drug on our formulary has a prior authorization or step therapy requirement or a quantity limit change it will be reflect in the updated formulary document.

2010

• 2010 Complete Classic Formulary (PDF)
• 2010 Complete Value Formulary (PDF)
• 2010 Complete Enhanced Formulary (PDF)

• 2010 Abridged Classic Formulary (PDF)
• 2010 Abridged Value Formulary (PDF)
• 2010 Abridged Enhanced Formulary (PDF)
  

2010 Drug Utilization Management Requirements

• 2010 Quantity Limit Requirements (PDF)
• 2010 Step Therapy Requirements (PDF)

2009

• 2009 Complete Classic Formulary (PDF)
• 2009 Complete Value Formulary (PDF)
• 2009 Complete Enhanced Formulary (PDF)
• Quality Assurance
• 2009 Negative Change Chart (PDF)

If a drug is removed from the formulary or is moved to a higher cost sharing tier, notification of the change will be posted on the website 60 days prior to the change. The notification will contain the following information:

• Name of the covered drug
• The date the formulary change becomes effective
• New formlary status of the drug
• Explanation of the change
• Alternative medications
• Links to information on the Medical Exception Process, Appeal, and Grievance

Drugs removed or moved to a higher cost sharing Tier (PDF)

This information is maintained on our website until our next annual mailing of the updated formulary