2026 Formulary (List of Covered Drugs) — Part 2 (drugs, vaccines, biologics; tiers and requirements/limits)
This document lists drugs, vaccines, biologics and associated benefit design attributes (Drug Tier and Requirements/Limits such as PA, QL, ACA, LA, SP, OTC, FF). It is a formulary/drug list excerpt (part of a larger formulary), not standalone prior authorization criteria.
No material clinical or coverage changes noted for this excerpt (has_material_change=false).
Coverage summary — formulary part / benefit design
Drug / vaccine groups and listed requirements
Formulary listing logic & entry-level criteria
Formulary listing logic & entry-level criteria
Formulary entries include the drug name, available strengths/forms, the formulary tier per product, and any Requirements/Limits (abbreviations explained above). The group below lists the top-level categories and each drug entry as a leaf enumerating per-product tier and Requirements/Limits.
ANY of the following
- ANTI-INFECTIVE AGENTS — Drug Tier: . — Requirements/Limits: .
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