List of Drugs (Formulary)

The formulary is a list of all the drugs that are covered by an insurance plan. The drugs listed in the formulary are covered as long as the drug is medically necessary, the prescription is filled through a network pharmacy or network mail order facility, and other coverage rules are followed. For some drugs, there are additional requirements or limits to coverage.

The drugs on the formulary are selected by pharmacy and health experts. The formulary is reviewed by a group of doctors and pharmacists who do not work for the health plan. This group is called the Pharmacy and Therapeutics Committee.

Not all drugs are included on the plan formulary. Some drugs are excluded from benefit coverage. In other cases, a mixture of medical and financial reasons are used to decide not to include a drug on the plan formulary.

Please see the list of drugs above for drugs that require approval by the plan (prior authorization), and other drugs that require you to try another drug before using the one your doctor ordered (step therapy).

Formulary Changes

Absolute Total Care may add or remove drugs from our formulary during the year. If we remove drugs or change the amount we will cover, you will be notified at least 60 days before the change. If the Food and Drug Administration (FDA) thinks a drug on our formulary is unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and notify you of the change.

If you have any questions, call Member Services at 1-855-735-4398. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711.

 

Last Updated: 09/30/2017 
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