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.
No material clinical/coverage changes in this update.
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).
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