Formulary

Commercial Plans

• Envolve Pharmacy Solutions - National Preferred Formulary - listed by Class
• Envolve Pharmacy Solutions - Exclusion Formulary
• Envolve Pharmacy Solutions - HDHP Preventive Drug List - Generic Only
• Ambetter from Coordinated Care - Washington Clinical and Payment Policies
• California Centene Employees HMO Formulary
• Centene Corporation - Employee Plan Preferred Formulary - listed by Class
• Celtic Insurance Company
• FBA of Syosset
• Lexington Home Brands - Exclusion Formulary
• North Dakota Workforce Safety & Insurance (WSI)
• Premium Hybrid
• Rice Lake Weighing System - Preferred Exclusion Formulary
• St. Louis County
• Synovus - Preferred Exclusion Formulary
• Upstream Intermediate HDHP Preventative Drug List
• Valir Health - Preferred Formulary

Medicaid

• Absolute Total Care 
  • Absolute Total Care - Preferred Drug List (PDF)
  • Absolute Total Care - Preferred Drug List (JSON)
• Arizona Complete Health
  • Arizona Complete Health - Integrated Preferred Drug List - English (PDF)
  • Arizona Complete Health - Integrated Preferred Drug List - Spanish (PDF)
  • Arizona Complete Health - Integrated Preferred Drug List (JSON)
  • Arizona Complete Health - Behavioral Health Preferred Drug List - English (PDF)
  • Arizona Complete Health - Behavioral Health Preferred Drug List - Spanish (PDF) 
  • Arizona Complete Health - Behavioral Health Preferred Drug List (JSON)   
• Buckeye Health Plan 
  • Buckeye Health Plan - Preferred Drug List (PDF)
  • Buckeye Health Plan - Preferred Drug List (JSON)
  • Buckeye Health Plan - MyCare Ohio (MMP) - Preferred Drug List (PDF)
  • Buckeye Health Plan - MyCare Ohio (MMP) - Preferred Drug List (JSON)
  • Ohio Department of Medicaid - State Unified Preferred Drug List
• California Health & Wellness
  • California Health & Wellness - Member Preferred Drug List - English (PDF)
  • California Health & Wellness - Member Preferred Drug List - Spanish (PDF)
  • California Health & Wellness - Preferred Drug List (JSON)
• Coordinated Care (Apple Health)
  • Coordinated Care (Apple Health) - Preferred Drug List (PDF)
  • Coordinated Care (Apple Health) - Preferred Drug List (JSON)
  • CCA Pharmacy Clinical and Payment Policies
• Health Net
  • Health Net Medi-Cal – Preferred Drug List (PDF)
  • Health Net Medi-Cal – Preferred Drug List (JSON)
  • Health Net CalViva Health – Preferred Drug List (PDF)
  • Health Net CalViva Health - Preferred Drug List (JSON)
• Louisiana Healthcare Connections
  • Louisiana Healthcare Connections - Preferred Drug List

• Magnolia Health Plan
  • Magnolia Health Plan - Preferred Drug List
• Managed Health Services - Indiana
  • MHS - Preferred Drug List (PDF)
  • MHS - Preferred Drug List (JSON)
  • MHS - Preferred Drug List - HIP Plus (PDF)
  • MHS - Preferred Drug List - HIP Plus (JSON)
• Nebraska Total Care
  • Nebraska Total Care - Preferred Drug List - English (PDF)
  • Nebraska Total Care - Preferred Drug List - Spanish (PDF)
  • Nebraska Total Care - Preferred Drug List (JSON)
  • Nebraska Total Care - State Preferred Drug List
  • Nebraska Total Care - Preferred Drug List - Claim Limitations (PDF)
• New Hampshire Healthy Families
  • New Hampshire Healthy Families - Preferred Drug List (PDF)
  • New Hampshire Healthy Families - Preferred Drug List (JSON)
• Peach State Health Plan
  • Peach State Health Plan - Medicaid Preferred Drug List (PDF) 
  • Peach State Health Plan - Medicaid Preferred Drug List (JSON) 
  • Peach State Health Plan - Inter-Pregnancy Care - Preferred Drug List (PDF) 
  • Peach State Health Plan - Family Planning - Preferred Drug List (PDF)
  • Peach State Health Plan - Family Planning - Preferred Drug List (JSON)
  • Peach State Health Plan - NADAC Summary Report 010121-043021 (PDF)
  • Peach State Health Plan - NADAC Summary Report 050121-083121 (PDF)
• Pennsylvania Health & Wellness
  • Pennsylvania Health & Wellness - Supplemental Drug List (PDF)
  • Pennsylvania Health & Wellness - Supplemental Drug List (JSON)
  • Pennsylvania Health & Wellness - State Supplemental Drug List
• SilverSummit Healthplan
  • SilverSummit Healthplan - Preferred Drug List (PDF)
  • SilverSummit Healthplan - Preferred Drug List (JSON)
• Sunflower State Health Plan
  • Sunflower State Health Plan - Preferred Drug List 
• Sunshine Health Plan
  • Sunshine Health Plan - Preferred Drug List
  • Sunshine Health Plan Preferred Diabetic Products
• Superior HealthPlan
  • Superior Health Plan - Preferred Drug List
• Trillium Community Health Plan
  
  • Trillium Community Health Plan - Preferred Drug List (PDF)
  • Trillium Community Health Plan - Preferred Drug List (JSON)
• Western Sky Community Care
  
  • Western Sky Community Care - Preferred Drug List (PDF)
  • Western Sky Community Care - Preferred Drug List (JSON)
• YouthCare HealthChoice Illinois
  • YouthCare HealthChoice Illinois - Preferred Drug List (PDF)
  • YouthCare HealthChoice Illinois - Preferred Drug List (JSON)