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:: Metallic Plan Drug Formulary - Plans Effective On or After 1/1/2014 ::

The list of covered drugs for QHP metallic plans that began on or after January 1, 2014, is available in a searchable PDF you can download here.

:: Prescription Drug Formulary Search ::
Some prescription drugs listed in this formulary may not be covered under your specific healthcare plan. To see the formulary specific to your group’s healthcare plan, you must login as a member.
Drug Name:   
Drug Class:   
Sub Class:   
 
 
 
  Formulary Benefit Levels
($) 1st Tier - Covered Perferred Generic Drugs
($$) 2nd Tier - Covered Preferred Brand Name Drugs
($$$)3rd Tier - Covered Non-Preferred Brand Name Drugs

 
This list is not all inclusive of drug classes or products, and may be subject to change as new products and information become available. Your pharmacist will advise you of your copay amount when filling a prescription for a drug that is not on the formulary. Please refer to your group's contract provisions for more detailed information about the terms and conditions of your prescription drug benefit.

*Medications identified as Narrow Therapeutic Index (NTI) medications will not be added to the Generic Listing, even if a generic equivalent is available. The NTI medications are identified with an asterisk (*) in the formulary listing on the previous pages.

This program does not apply to the Medicare Discount program. Click here to search the True Blue HMO and Secure Blue PPO Prescription Drug formulary.
 
GE=Generic Equivalent Prescriptions: Covered Preferred and Non-Preferred Brand Name Drugs on the Generics Equivalent Listing. Member pays the difference between the cost of the preferred generic and the brand name drug plus the applicable non-preferred brand name copay.

PA=Prior Authorization: Certain drugs require prior authorization. If you do not obtain prior authorization of that drug. Please follow the guidelines for prior authorization in your group`s contract provisions in order to get the most out of your pharmacy benefit.

QL=Quantity Limits: There are some drugs that may be less effective or even dangerous when taken at higher than normal doses. These drugs have quantity limits consistent with the manufacturers` recommendations.

ST=Step Therapy: You may need to use one or more medications before benefits for the use of another medication can be authorized.