Custom Premium Drug List

Closed Formulary

The prescription drug benefit information provided through the use of this website is subject to all terms, conditions, limitations and exclusions of the member's benefit plan. Please consult the Summary of Benefits for a complete description of the prescription drug benefit. In the event of a discrepancy between information provided on this website and the benefit plan booklet, the terms of the benefit plan apply.

To see drug-specific pharmacy coverage guidelines (PCGs), search for a drug name in the searchable tool, or download the PCG list below.

View "How-to" Guide for easy instructions for using this tool!