Drug Formulary

2021 Medicare-Medicaid Plan/Dual Options Drug Formulary

Additional Pharmacy Benefit Information:

2021 Prior Authorization for Pharmacy
2021 Prior Authorization Grid
2021 Step Therapy Grid
2021 How to Request a Re-Determination

Click here if one of your patients is looking for the Coverage Determination Request Form, the Pharmacy Direct Member Reimbursement Form or other member forms.


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