Plan Documents and Resources
Summary of Benefits
Annual Notice of Changes
Evidence of Coverage
Plan Ratings
Enrollment Form
Extra Help
Pharmacy Information
Formulary
Online Formulary Search
Comprehensive Formulary – Updated on 11/1/2017
Formulary Changes – Updated on 11/1/2017
Step Therapy – Updated on 11/1/2017
Quantity Limit – Updated on 11/1/2017
Pharmacy Prior Authorization – Updated on 11/1/2017
Part D Coverage Determination
Online Coverage Determination/Redetermination
Part D Coverage Determination Request Form
Part D Coverage Redetermination Request Form
Other Resources
Pharmacy Search
Medication Transition Policy
Medication Therapy Management
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