Pharmacy/Drug Coverage

Standard Pharmacy Plans


Select the correct formulary below:


Standard 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.

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Additional Resources

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Legal Disclaimer: Information provided is subject to all terms, conditions, limitations, and exclusions of your benefit plan. In the event of any discrepancy, the claims adjudication system and your benefit plan take precedence.