Custom Formulary

Refer to the Custom Formulary (PDF) when prescribing medications for members with three-tier or closed (managed) formulary plans. Under the closed (managed) formulary benefit design, drugs listed as tier three (nonformulary brand) are not covered unless we authorize them as medically necessary. 

You can also use the Custom Formulary Quick Guide (PDF) to find the medications within the most commonly prescribed therapeutic classes. 

Formulary Updates

The Custom Formulary listing is updated twice a year. Since a drug's status may change and new drugs may be added to the formulary, we also publish a list of formulary updates to keep you informed of those changes.

Download recent Custom Formulary updates (PDF).

Questions? We can help!

To verify a member's benefit plan or get answers to your pharmacy-related questions, please contact us.