List of Drugs (Formulary)

How Do I Search for a Drug in the List of Drugs (Formulary)?

You can search for a drug by using our Drug Search Tool or by opening the List of Drugs (Formulary) PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives. 

The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the drug list as a PDF document. The drug list is updated monthly.

List of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before we make one of the following changes to the list of drugs:

• Remove a drug from the list.
• Change drug requirements.
• Move a drug to a higher cost sharing tier.

If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug. To view the changes, open the List of Drug Change Notice PDF document below.

Drug Coverage Determinations

You can ask us to make an exception to our coverage rules for your drug(s). To learn about the types of exceptions, refer to your Evidence of Coverage or Member Handbook. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.

Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You or your doctor can request a fast (expedited) exception if your health may be harmed by waiting. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s supporting statement.

Generic Drugs

We cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug.  

Generic drugs are are FDA-approved and are as safe and effective as brand name drugs. They have the same active ingredients, indications, dosages, safety, and strengths as the brand name drugs and generally cost less. Ask your doctor if any of your drugs are available as a generic, and if a generic version will work for you. 

Mail Order Service

You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service—Express Scripts® Pharmacy. You can find more information about receiving your prescriptions through mail service delivery on our Mail Order Service page.

List of Drugs (Formulary)

How Do I Search for a Drug in the List of Drugs (Formulary)?

You can search for a drug by using our Drug Search Tool or by opening the List of Drugs (Formulary) PDF document. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives. 

The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key. You also have the option to print the drug list as a PDF document. The drug list is updated monthly.

          Updated November 7, 2024:

Alternative Drug List 

Are you currently taking a drug that is not covered on your plan’s List of Drugs (formulary)? The form below is a partial list of the drugs that are not covered, along with their covered alternative drugs. Talk to your provider to see if the drug alternatives listed in the PDF form below will work for you. 

Alternative Covered Drug List (HMO) (C-SNP) - English (PDF) 

Alternative Covered Drug List (D-SNP) - English (PDF)

Alternative Covered Drug List (Cal-Viva) - English (PDF)

List of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before the following changes are made to the list of drugs:

• Remove a drug from the list.
• Change drug requirements.
• Move a drug to a higher cost sharing tier.

If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. In addition, if a new generic drug comes to market, we may remove the brand name drug.

Drug Coverage Determinations

You can ask us to make an exception to our rules for your drug(s). To learn about the types of exceptions, refer to your Evidence of Coverage or Member Handbook. When asking for an exception, include a statement from your doctor that supports your request, plus a completed Coverage Determination form.

Generally, we must decide on your request within 72 hours after we get your doctor’s statement. You or your doctor can request a fast (expedited) exception if your health may be harmed by waiting. If we approve your expedited request, we must give you a decision within 24 hours after we get your doctor’s supporting statement.

Generic Drugs

We cover both brand name drugs and generic drugs. Generic drugs have the same active ingredient formula as a brand name drug.  Generic drugs are FDA-approved and are as safe and effective as brand name drugs. They have the same active ingredients, indications, dosages, safety, and strengths as the brand name drugs and generally cost less. Ask your doctor if any of your drugs are available as a generic, and if a generic version will work for you.

Mail Order Service

You can fill your prescription at any network pharmacy. You also can fill your prescription through our preferred mail order service—Express Scripts® Pharmacy. You can find more information about receiving your prescriptions through mail service delivery on our Mail Order Service page.