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Generic or brand Drug that will yield the lowest cost in copay to you and your plan.
The most common reasons there are no results found for the drug you selected is that the drug is not covered under your closed formulary or it is available Over the Counter (OTC) and does not require a prescription.
Type the Generic Equivalent name in the drug search box for a complete listing of options for this Generic.
comprehensive drug list is a list of covered drugs selected by your plan. The drug list is available for print in a PDF format.
The Coverage Determination form is used to submit a request for review based on a denial of a prescription medication or for a request to provide coverage for a
medication that is not currently available on your prescription plan. Please print the form and take it to your prescribing physician to complete and sign and
fax to the Clinical Department for review.
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