2019 Individual & Family Plans 
Formulary (List of Covered Drugs)

Download the complete Formulary or search the list of covered drugs below.

Individual & Family Plans Formulary (PDF) Updated 01/10/2019

Prior Authorization Criteria (PDF) Updated 01/10/2019
Step Therapy Criteria (PDF)  Updated 09/01/2018

Specialty Pharmacy Drug List (PDF) Updated 04/01/2018


October 2018