Formulary
(List of Covered Drugs)
Network PlatinumPlus Pharmacy, Network PlatinumPremier Pharmacy and Network PlatinumSelect Formulary
The Formulary provides coverage information about some of the drugs covered in our plans that have Part D prescription drug coverage. You may search, browse or use the alphabetical index to locate your drug. Network Health Insurance Corporation Pharmacy may add or remove drugs from our Formulary during the year. If we remove drugs from our Formulary, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug.
All Part D plans from Network Health Insurance Corp. cover both brand name drugs and generic drugs, and include over 50,000 network pharmacies. Generic drugs have the same active ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs." Brand-name drugs are capitalized (e.g., SINGULAIR) and generic drugs are listed in lower-case italics (e.g., warfarin).
The information in the "Requirements/Limits" column tells you if your plan has any special requirements for coverage of your drug.
- Medication Therapy Management (MTM)
- Plan Transition Process
- Out Of Network Pharmacy Information
- Restrictions On Coverage
- 2010 Prior Authorization Criteria
- Utilization Management and Quality Improvement Procedures
- Step Therapy Criteria
- Quantity Level Limits
- 2010 Low Income Subsidy Premium Table
Find Your Prescriptions
As we age, the likelihood - and often the amount - of prescription drugs we need increases. Enrolling in a health plan that includes valuable Medicare Prescription Drug coverage now will help you save money, providing the important "safety net" you need in the future. So even if you don't need prescription drugs now, you'll have the peace of mind knowing you have the right coverage when you need it most.
To obtain a tiering exception to the Plan’s drug formulary, download the Medicare Prescription Drug Coverage Determination Form that you can complete and take to your prescribing physician’s office.
Find your prescriptions in your plan:
Search 2010 Formulary:
- Search the 2010 Formulary, Formulary ID 10140, Version 17
- Upcoming Changes to the Formulary
- CMS Best Available Evidence (BAE) Policy
Download the 2010 Formulary (PDF Format)
Are you a new plan member? Learn about our Plan Transition Process.