For a list our preferred Biosimilars, please reference our Biosimilar Chart

For a list of the most Common Drugs Requiring Preauthorization, please reference our Preferred Drug List

For a complete list, please reference our Complete Formulary

These exclusions are in addition to those listed on the Complete Formulary above


Important Points to Remember:

  • The printed version may not contain the most current formulary information
  • Medications requiring prior authorization are shaded on the formulary
  • Some over-the-counter drugs are covered by the drug plan
  • Providers and pharmacies can contact the following number for prescription assistance: 844.825.9319.

For Updates and Assistance:

  • If you need further assistance, please contact:
  • Benefit coverage questions may be directed to Health Tradition Customer Service toll-free at  844.825.9319.
  • Prior authorization questions may be directed to MedImpact at 888.728.5057.