Drug Formulary

Avoid High Medication Costs

Ask your doctor to choose a drug from this covered list.

Drug Formulary Alphabetical (pdf)
Special 90-Day Drug Formulary (pdf)



30-day supply of generic drugs


90-day supply of certain generic drugs*


30-day supply of brand-name drugs that are not available generically

*90-day formulations and dosages may vary and are at the discretion of the pharmacy.

Search the Formulary

Search Tips
Search on terms that appear in any column. Examples: “diabetes generic”, “cardio 90 day” or “cholestyramine”.
To sort by multiple columns, sort the first column then hold the shift key as you sort the second column.

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