I Want to See

search icon

I Want to See

Pharmacy Resources & Forms

Drug Lists     

We strive to offer our members many convenient and affordable ways for members to purchase prescriptions and medications. Working with you, members can use the appropriate prescription drug lists below to make smart choices about the drugs they take and the amount they pay. 

 

Preferred Formulary 

 

Essential Formulary
(Marketplace, Individual and Small Group Commercial Plans)

 

Miscellaneous

Tools & Forms

Provider specific information to help manage plan member's health.

 

Provider Forms

Drug Authorization Forms

  • Pharmaceutical Exception Request Form
    Use this form for requesting an exception when a drug authorization form is not available.
  • Medication Review Request Fax Cover
    Use this fax cover sheet if your authorization request was denied and you are requesting an appeal, or if you are requesting review for coverage of an excluded pharmacy product. Please note: This form is a cover sheet only. You are required to submit pertinent medical information that supports the pharmacy related request along with this fax cover form.

Tools

Pharmacy Programs