Drug Formulary
2022 Medicare-Medicaid Plan/Dual Options Drug Formulary
2021 Medicare-Medicaid Plan/Dual Options Drug Formulary
Additional Pharmacy Benefit Information
2022 Prior Authorization for Pharmacy
2022 Prior Authorization Grid
2022 Step Therapy Grid
2021 Prior Authorization for Pharmacy
2021 Prior Authorization Grid
2021 Step Therapy Grid
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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