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Custom Formulary
The Custom Formulary is used with three-tier copay or closed (managed) formulary plans only. If you're not sure whether your plan uses the Custom Formulary, check your prescription drug benefit packet or contact customer service.
Try our automated formulary look-up tool.
Benefit Coverage and Limitations: Many members have specific benefit inclusions, exclusions, copays, or a lack of coverage, which are not reflected in the automated drug formulary look-up tool. The automated drug formulary applies only to outpatient drugs provided to members, and does not apply to medications used in inpatient settings.
Drugs in our Custom Formulary (PDF) are categorized as follows:
- Tier 1 — Generic (Formulary Preferred)
- These drugs have a proven record of safety and effectiveness and offer the best value. Tier 1 drugs require the lowest copayment, making them your most cost-effective option for treatment. All generic drugs are Formulary Preferred.
- Tier 2 — Formulary Brand (Formulary Options)
- These brand-name drugs also have a record of safety and effectiveness. Because more cost-effective therapy or a generic alternative is usually available, drugs in Tier 2 require a higher copayment.
- Tier 3 — Nonformulary
- Nonformulary brand-name drugs are not included in our Custom Formulary. Tier 3 drugs may not have a proven record for safety or their clinical value may not be as high as the drugs in Tier 1 or Tier 2. Formulary alternatives are available. Depending on your plan's drug rider, you may pay a higher copayment for Tier 3 drugs than for those in Tier 1 or Tier 2, or even be responsible for the entire cost.
Formulary updates
The Custom Formulary listing is updated twice a year. Since a drug's formulary status may change throughout the year, we also publish a list of formulary updates to keep you informed.
Questions? We can help!
If you have questions about your prescription drug benefits, please contact customer service.
