WebThe document represents a closed formulary plan design. Certain medications on the list are covered if utilization management criteria are met (i.e., Step Therapy, Prior Authorization, Quantity Limits, etc.); ©2024 CVS Health and/or one of its affiliates. WebWhat Medicare Part D drug plans cover. All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary.
Prescription Drug Information - Fidelis Care
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Drug List - Marketplace Home
WebThe Medication Request Form is submitted by participating physicians and providers to obtain coverage for formulary drugs requiring prior authorization (PA); non-formulary drugs for which there are no suitable alternatives available; and overrides of pharmacy management procedures such as step therapy, quantity limit or other edits. WebSection 1:Alphabetically by drug category (such as Diabetes, Heart or Pain/Arthritis) Locate a category and drug on the guide and you will see the tier and copayment for that drug—Tier 1, Tier 2 or Tier 3—which determines your copayment. To determine if a drug is a generic or brand-name medication, look at the name of the drug. Web2024 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary ID 21426, Version 22 This formulary was updated on 12/01/2024. For more recent information or other questions, please contact schwinn exercise bike seat replacement