A formulary is a list of drugs that are covered by your health plan. Each drug in the formulary is listed alongside its tier, which you can use to find out how your plan covers the drug. The formulary also provides details on any authorizations, restrictions or limits that may apply to ...
A prescription drug tier list, also referred to as a formulary, is used to determine what you pay out of pocket for prescription medications. They list which medications are covered by your health insurance plan and what they’ll cost you. ...
HealthNet's3TierRecommendedDrugList Tier1Tier2Tier3(NotonTheDrugList) Acetaminophen/CodeineTabletsAVINZACAPSULES(QL)ABSTRALSUBLINGUALTABLETS(PA) Acetaminophen2.5/Hydrocodone1.67ElixirCODEINETABLETSACTIQLOZENGES(PA) Acetaminophen325/Hydrocodone5TabletsDARVONCPD.CAPSULESButorphanolNasalSpray(QL) ...
2024 IL HMO Pharmacy Benefit Drug List Changes Starting January 1, 2024, some prescription drugs for Illinois HMO may: • Move to a higher or lower drug tier • Be added or removed from the drug list • Have a new special requirement Below is a list of drugs in alpha order that ...
However, if you or your health care provider believe that you need a specific drug that’s not included on your plan’s formulary, you can apply for a special exception. The insurance company might grant the exception if your prescriber can demonstrate that the drug is medically necessary beca...
(Zithromax) 2 3 1 1 3 3 1 1 1 1 1 3 3 3 3 3 3 3 3 3 3 3 2 1 1 1 1 • • 2 BCBSTX Health Insurance Marketplace 3 Tier Standard Preferred Drug List October 2015 2015 Drug Name azithromycin tab 600 mg (Zithromax) BIAXIN - clarithromycin for susp 250 mg/5ml BIAXIN -...
As a member of a health plan that includes outpatient prescription drug coverage, you have access to a wide range of effective and affordable medications. The health plan utilizes a Preferred Drug List (PDL) (also known as a drug formulary) as a tool to guide providers to prescribe ...
Preferred Drug List (PDL) Nebraska Heritage Health Effective Date: January 1, 2025 Preferred drug list Introduction This Preferred Drug List (PDL) Reference Guide gives you information that explains how covered medications are selected; exclusions and limitations; and steps to take when a medication ...
Our drug list and prescribing guidelines is a tool for the management of the quality and cost of drug therapy. The scope of these guidelines is limited to ambulatory drugs. Those concerned with the prescribing, dispensing, and reimbursement of medicines may refer to this service in choosing quali...
Health Insurance Exchange 5 Tier Generics Plus Preferred Drug List October 2015 2015 Drug Name SOLODYN - minocycline hcl tab sr 24hr 115 mg TARGADOX - doxycycline hyclate tab 50 mg TETRACYCLINE HCL - tetracycline hcl cap 250 mg TETRACYCLINE HCL - tetracycline hcl cap 500 mg VIBRAMYCIN - ...