List of Drugs (Formulary)
- 2018 List of Drugs (Formulary) - English (PDF)
- Lista de Medicamentos Cubiertos para 2018 - Español (PDF)
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).
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.
Our list of drugs (formulary) shows the drugs we cover. The list includes:
- Medicare Part D drugs
- Some Medicaid covered prescription and over-the-counter drugs and items
In general, we cover drugs if they are medically necessary. Drugs on the list of drugs are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.
The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves the list of drugs. We don’t include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.
How do I search for a drug in the List of Drugs?
You can search for a drug by using the search tool, alphabetical index or by medical condition.
Search Tool: Open the drug list (PDF). Hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug. Press the “Enter” key.
Alphabetical Index: The index at the end of the PDF lists the names of generic and brand name drugs from A to Z. Once you find a drug name, go to the page number listed to see if the drug is covered.
Medical Condition: The drugs are grouped into categories by type of medical condition that they are used to treat. For example, “Cardiovascular Agents – Drugs to Treat Heart and Circulation Conditions.” If you know what your drug is used for look through the list to find the category. Then look under the category for your drug.
- 2018 List of Drugs (Formulary) - English (PDF) – coming soon
- Lista de Medicamentos Cubiertos para 2018 - Español (PDF) – coming soon
- How to request a List of Drugs by Mail (PDF) – coming soon
Drug Change Notice
Drugs may be added or removed from our list of drugs during the year. We will tell you 60 days before the following changes are made to the list of drugs:
- Remove a drug from the list
- Change drug requirements
- Move a drug to a higher cost sharing tier
If the Food and Drug Administration (FDA) or the drug’s maker says a drug is not safe, it will be removed from our list of drugs right away. To view the changes, open the PDF list below.
Drug List Changes (PDF) - coming soon
If you have questions about our list of drugs, or want the most recent version, contact Member Services. We are here to help.