2024 Approved Drug List
- Commercial/Individual prior authorization criteria
- Pharmacy drug request
- Oral oncology drug request
- Opioid quantity limit exception request
Drugs covered under the medical benefit
- Medical Benefit Drug List (MBDL) (formerly the Injectable drug list)
- Medical drug request
- Oncology medical drug request
Medical drug-specific forms are linked in the Medical Benefit Drug List
Select Specialty Medications for eligible members may be able to obtain copay assistance through SaveOn.
If you have an HSA plan, you may receive additional coverage through your employer for certain medications. This coverage is called a plan rider. Check your plan documents to see whether one of the below riders is included in your plan.