Covered drugs
2024
2025
Arizona
Standard plans - 4 Tier formulary
Arizona
All other plans - 6 Tier formulary
Florida
Standard plans - 4 Tier formulary
Florida
All other plans - 6 Tier formulary
Georgia
Standard plans - 4 Tier formulary
Georgia
All other plans - 6 Tier formulary
Illinois
Standard plans - 4 Tier formulary
Illinois
All other plans - 6 Tier formulary
Iowa
Standard plans - 4 Tier formulary
Iowa
All other plans - 6 Tier formulary
Kansas
Standard plans - 4 Tier formulary
Kansas
All other plans - 6 Tier formulary
Michigan
Standard plans - 4 Tier formulary
Michigan
All other plans - 6 Tier formulary
Missouri
Standard plans - 4 Tier formulary
Missouri
All other plans - 6 Tier formulary
Nebraska
Standard plans - 4 Tier formulary
Nebraska
All other plans - 6 Tier formulary
New Jersey
All Plans - Formulary
New York
All Plans - Formulary
North Carolina
Standard plans - 4 Tier formulary
North Carolina
All other plans - 6 Tier formulary
Ohio
Standard plans - 4 Tier formulary
Ohio
All other plans - 6 Tier formulary
Oklahoma
Standard plans - 4 Tier formulary
Oklahoma
All other plans - 6 Tier formulary
Pennsylvania
Standard plans - 4 Tier formulary
Pennsylvania
All other plans - 6 Tier formulary
Tennessee
Standard plans - 4 Tier formulary
Tennessee
All other plans - 6 Tier formulary
Texas
Standard plans - 4 Tier formulary
Texas
All other plans - 6 Tier formulary
Virginia
Standard plans - 4 Tier formulary
Virginia
All other plans - 6 Tier formulary