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Printable Drug Lists
Note: Your plan's covered drug list may vary from this standard formulary. Call the Customer Service number on your ID card or consult your group administrator to verify this formulary.

Formulary One-2012 (PDF)

Maintenance Drugs (PDF): Medications considered to be necessary for long periods of time.

Prior Authorization List (PDF): Medications that require prior approval. For authorization, call 1-877-433-2973.

Printable Drug Lists



 
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