Formulary

Commercial Plans

• Ambetter from Coordinated Care - Washington Clinical and Payment Policies

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 - 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
• CARE1st Health Plan Arizona
  • CARE1st Arizona - Integrated Preferred Drug List - English (PDF)
  • CARE1st Arizona - Integrated Preferred Drug List - Spanish (PDF)
  • CARE1st Arizona - Integrated Preferred Drug List (JSON)
  • CARE1st Arizona - Behavioral Health Preferred Drug List - English (PDF)
  • CARE1st Arizona - Behavioral Health Preferred Drug List - Spanish (PDF) 
  • CARE1st Arizona - Behavioral Health Preferred Drug List (JSON)   
• Coordinated Care (Apple Health)
  • Coordinated Care (Apple Health) - Preferred Drug List (PDF)
  • Coordinated Care (Apple Health) - Preferred Drug List (JSON)
  • CCW Pharmacy Clinical and Payment Policies
  • Prior Authorization Forms
• Delaware First Health
  • Delaware First Health - Medicaid Preferred Drug List (PDF)
  • Delaware First Health - Medicaid Preferred Drug List (JSON)
• Louisiana Healthcare Connections
  • Louisiana Healthcare Connections - Preferred Drug List

• Magnolia Health Plan
  • Magnolia Health Plan - Preferred Drug List
• Meridian - Illinois HealthChoice Medicaid
  • Meridian - Illinois HealthChoice Medicaid - Preferred Drug List (PDF)
  • Meridian - Illinois HealthChoice Medicaid - Preferred Drug List (JSON)
• Meridian - Michigan
  • Meridian - Preferred Drug List (PDF)
  • Meridian - Preferred Drug List (JSON)
  • Meridian - Children's Special Healthcare Services (CSHCS) Preferred Drug List (PDF)
  • Meridian - Children's Special Healthcare Services (CSHCS) Preferred Drug List (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)
  • Peach State Health Plan - NADAC Summary Report 090121-123121 (PDF)
  • Peach State Health Plan - NADAC Summary Report 010122-043022 (PDF)
  • Peach State Health Plan - NADAC Summary Report 050122-083122 (PDF)
  • Peach State Health Plan - NADAC Summary Report 090122-123122 (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 - English (PDF)
  • Trillium Community Health Plan - Preferred Drug List - Spanish (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)