Disclaimer: The medications listed in this formulary are subject to change pursuant to the formulary management activities of the participating health plans.

This list is not all-inclusive nor does it imply a guarantee of coverage. In addition, coverage for some drugs listed may be limited to specific dosage forms and/or strengths. Substitution of a generic product for a brand name drug is mandatory when a generic equivalent is available. If a member requests the brand name drug in this situation, a pharmacy exception may be required and the member must pay the difference in cost between the generic and branded versions.