We review our drug list on a monthly basis and make changes as necessary. Most changes are positive. An example would be adding new generics that have come on the market.
Sometimes we have to make a negative change to our formulary, like if the FDA views a drug as unsafe or if the drug maker removes the drug from the market.
Some drugs have rules you need to follow before we cover them. These include:
You and your doctor can ask us to make an exception to one of our coverage rules. This includes requesting an exception to a prior authorization, quantity limit or step therapy rule.
There may be times where you’re taking a drug that either isn’t on our drug list or has special rules before we cover it. Learn about our transition process to see if you’re eligible for a short-term supply of medication. This temporary supply allows you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
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