CurrentCommunity-CarePolicy N/A

Search 2026 Prescription Drugs

A plan formulary describing covered prescription drugs, tiers, copay/coinsurance by plan variant, coverage restrictions (PA, QL, ST), drug listings by therapeutic categories with per-drug tier assignments and requirements/limits, and member/provider instructions for exceptions and temporary supplies. This part contains introductory policy, tier and benefit cost-sharing tables, abbreviation definitions, and a partial alphabetical/therapeutic drug listing with requirements/limits.

Policy Summary

PayerCommunity-Care

PolicySearch 2026 Prescription Drugs

Policy CodePolicy N/A

Change TypeFormulary update (partial extract)

Effective Date05/22/2026

Next Review DateN/A

Key ActionProviders must obtain prior authorization for drugs listed with 'PA' or 'PA_NSO' or 'PA_BvD' before dispensing; without PA the plan may not cover the drug.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes in this update.

05/22/2026Formulary updated as of

manyDrug entries listed (partial extract)

PA/QL/STCoverage restrictions applied

multipleHigh-tier specialty agents present

manyProducts marked NDS

Coverage Summary & Preconditions

Formulary Coverage Preconditions and Restrictions

Covered when ALL of the following preconditions are met:

ALL of the following

Prescription is written by a licensed prescriber and is for a drug included in the plan formulary or approved via exception.
Prescription is filled at a plan network pharmacy, unless an approved non-network pharmacy exception applies.
Members generally must use network pharmacies to obtain Part D benefits.
For drugs subject to prior authorization, prescriber has submitted an approved prior authorization request before the drug is dispensed.
See callout: Prior Authorization Required.
Quantity limits: prescribed amount does not exceed the plan's quantity limit for the drug (per fill or per defined time period).

Policy Summary

PayerCommunity-Care

PolicySearch 2026 Prescription Drugs

Policy CodePolicy N/A

Change TypeFormulary update (partial extract)

Effective Date05/22/2026

Next Review DateN/A

Key ActionProviders must obtain prior authorization for drugs listed with 'PA' or 'PA_NSO' or 'PA_BvD' before dispensing; without PA the plan may not cover the drug.

SourceLink

On This Page

Temporary supply rules

In the event of a formulary change affecting a drug a member is currently taking, the member may receive a one-time temporary supply of up to a 30-day supply while transition/exception is pursued.
We will notify affected members as required when changes affect their current therapy.
For immediate substitutions (e.g., new generic or interchangeable biosimilar added), pharmacies may dispense the substitutable product per state substitution laws; members/prescribers may request an exception to continue original product.
Immediate changes follow Medicare guidance for allowable mid-year modifications.

Formulary Exception and Appeal Timing

Medicare timelines for formulary exception decisions (standard and expedited):

ALL of the following

Standard exception request: We will make a decision and provide notice within 72 hours of receiving a complete standard exception request. If additional information is needed, we will request it and the 72-hour clock pauses until the information is received.
This aligns with Medicare Part D adjudication timelines for exceptions.
Expedited (urgent) exception request: We will make a decision and provide notice within 24 hours of receiving a complete expedited exception request when the prescriber certifies that standard timing could seriously jeopardize the patient’s health or ability to obtain, maintain, or regain maximum function.
If more information is needed, we will request it and the 24-hour clock pauses until the information is received.
If we deny an exception (standard or expedited), the member has the right to request a coverage determination and appeal, and to receive instructions on how to request an expedited appeal if appropriate.
See member communications and appeals sections for procedures and contact information.

This formulary (Senior Health Plan: Platinum, Platinum Plus, Silver Plus, EGHP+D, and Oklahoma Dual Complete) covers Part D prescription drugs for the listed plans. Coverage applies to drugs included on the plan’s formulary as of the last update (05/22/2026) subject to medical necessity, network pharmacy requirements, and plan-specific utilization controls (prior authorization, step therapy, quantity limits, and formulary tiering). The tier tables and utilization controls described in the formulary apply to the Platinum, Platinum Plus, Silver Plus, and Oklahoma Dual products indicated in the document.

Benefit Tier Cost-Sharing & Abbreviations

Platinum & Platinum Plus — Tier 1 (Preferred Generics)mixedCovered

Tier 1	Preferred Generic
INS	Insulins
ST_NSO	Short-Term / Non-Sustained-Only
VAC	Vaccines
amphetamine/dextroamphetamine 10mg er cap	amphetamine/dextroamphetamine 10mg extended-release capsule
amphetamine/dextroamphetamine 10mg tab	amphetamine/dextroamphetamine 10mg tablet
lisdexamfetamine dimesylate 10mg cap	lisdexamfetamine dimesylate 10mg capsule
atomoxetine 100mg cap	atomoxetine 100mg capsule
guanfacine 1mg er tab	guanfacine 1mg extended-release tablet
armodafinil 150mg tab	armodafinil 150mg tablet

1–10 of 14

1/2

Platinum & Platinum Plus — Tier 2 (Generic / Preferred Brand)mixedCovered

Tier 2	Generic / Preferred Brand
leflunomide 10mg tab	leflunomide 10mg tablet
OLUMIANT 1MG TAB	Olumiant 1mg tablet
RINVOQ 1MG/ML ORAL SOLN	Rinvoq 1mg/mL oral solution
XELJANZ 5MG TAB	Xeljanz 5mg tablet
CIMZIA 200MG INJ	Cimzia 200mg injection
ENBREL 25MG/0.5ML INJ	Enbrel 25mg/0.5mL injection
celecoxib 100mg cap	celecoxib 100mg capsule
diclofenac sodium 1.5% topical soln	diclofenac sodium 1.5% topical solution
ketorolac tromethamine 10mg tab	ketorolac tromethamine 10mg tablet

Oklahoma Dual Complete & Silver Plus — Tier 3/4/5 (Enhanced / Specialty)mixedCovered

Tier 3	Non-Preferred Brand
Tier 4	Specialty / High Cost
Tier 5	Non-Covered / Highest Cost
fentanyl 100mcg/hr patch	fentanyl 100 mcg/hour transdermal patch
hydromorphone 2mg tab	hydromorphone 2mg tablet
methadone 10mg tab	methadone 10mg tablet
morphine sulfate 100mg er tab	morphine sulfate 100mg extended-release tablet
mazepine 300mg er cap	mazepine 300mg extended-release capsule
carbamazepine 400mg er tab	carbamazepine 400mg extended-release tablet
DIACOMIT 250MG CAP	Diacomit 250mg capsule

1–10 of 110

1/11

Per-drug Requirements & Limits — Abbreviationsmixed

Prior Auth (PA)	Prior Authorization required per plan rules
QL	Quantity Limit
ST	Step Therapy
ST_NSO	Short-Term / Non-Sustained-Only
INS	Insulins — separate coverage and copay rules apply
VAC	Vaccines — typically covered under medical benefit unless otherwise listed

OpenPayer

Search 2026 Prescription Drugs

Coverage Summary & Preconditions

Formulary Entries, Tiers, and Utilization Controls

Benefit Tier Cost-Sharing & Abbreviations

Sample Formulary Drug Entries & Flags (partial)

Provider Requirements & Operational Actions

Formulary Index & Cross-References (alphabetical fragments)

Definitions, Abbreviations & Quantity Limit Thresholds

Revision History