PREFERRED DRUG FORMULARY PROGRAM
Click on one of the following to view:
2 Tier Copay Chart
3 Tier Copay Chart
Accu-Check Blood Glucose Monitoring System
Act 98 - Diabetic Supplies
Drugs Exempt from Mandatory Generic Provisions
Drug Formulary (Preferred Drug List) includes Prior Authorization, Step Therapy and Quantity Limit Requirements
Home Infusion Prior Authorization Form
Prescription Reimbursement Drug Form
Prior Authorization Form
No News Can Be Good News
Policies and Procedures
Specialty Pharmacy Medications and Providers
Utilization Management Criteria
Updated: 10/23/07