A formulary is a list of covered drugs created in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.
The covered drugs are listed on the formulary as long as the medication is medically necessary, the prescription is filled at a Dean Advantage network pharmacy, and other plan rules are followed. Please review your Evidence of Coverage for more detailed information about your formulary and how to fill your prescriptions.
If a drug is not listed in your drug formulary, the product is not covered under your pharmacy benefit. If you decide to fill a prescription for a product not on the formulary, you are responsible for 100% of the cost. The cost is also not counted toward deductibles or out-of-pocket maximums.
View the 2024 comprehensive formulary (PDF) updated 2/1/24
If you have a question about covered drugs or would like a formulary mailed to you, call our Customer Care Center at 1-877-232-7566 (TTY: 711).
Generally, if you are taking a drug on our current year formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released.
If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
Review the Pharmacy Transition Process page to learn more about exceptions when you are a new member or other special situation.As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription.