Network Health has a comprehensive list of covered drugs, which is also referred to as a Formulary or Preferred Drug List. This search contains the drugs Network Health covers under our plans. It includes the most commonly covered medications with information about drug tiers and any restrictions or special requirements. To find if a medication is covered, choose a Network Health plan type from the drop down below. Use Chrome for the best user experience. The formulary may change at any time. If you're a member and you're not already signed in, go to My Login to sign in to your member portal account for the most accurate results.
We may add or remove drugs from our formulary during the year. This includes changes to prior authorization requirements, step therapy, quantity limits and/or moving a drug to a higher cost-sharing tier.
We may add or remove drugs from our formulary during the year. In certain situations, if we remove drugs, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify members who take the drug of the change at least 60 days before the change becomes effective (or when a member requests a refill). For changes made to the formulary due to a new generic becoming available for a brand name drug, drugs removed from the formulary for safety reasons or because the drug is being removed from the market, a 60-day notice is not required. We will notify members no later than 30 days after those types of formulary changes are made.
Closed Formulary Negative Changes
When you find your drug, it will be listed with a tier number. For plans with multiple tiers, the tier number for a drug determines what you pay for the drug. Generally, the higher the tier, the more you pay. To find your pharmacy benefit costs for each tier, go to My Login and sign in to your member portal account (once signed in, go to My Benefits and then Pharmacy Benefits).
If you prefer a printed copy of your plan’s drug list, please call the member experience number listed on the back of your ID card. Alternatively, you may print the PDF located within the formulary search.
Please note these lists change often, so make sure you have the most up-to-date version when searching for your drug. To use these lists, find your drug in the Index at the end. Then, scroll through the Index to find the page number for your medication and go to that page to find information about your medication.
For additional information related to our Network Health Medicare Advantage Plans and the Medicare formulary, see the Medicare Formulary Information section on the Medicare Pharmacy Information page. The 2025 Medicare Formulary was last updated on April 1, 2025.
Network Health's Pharmacy and Therapeutics Committee determines medication tiering and utilization management criteria based on clinical evidence, safety, cost and national recognized therapeutic guidelines. If your prescribed medication is not covered or partially covered, you or your prescriber can ask us to cover it. This is considered an exception.
Exceptions can be handled both externally and internally. Exceptions usually require a supporting statement from your prescriber explaining why alternative medications are not sufficient.
A decision will be made regarding your exception within the established standard time frames for review, after receiving all the necessary information. This includes the supporting statement from your prescriber. You can request an expedited decision if you or your doctor feel your health could be harmed by waiting for a standard decision. If your expedited request is granted, a decision will be provided within the established expedited time frame for review, after receiving the supporting statement from your prescriber.
The following Network Health client companies do not use Network Health for processing their pharmacy benefits.
Employees of this company should check with their human resources department for more information about pharmacy benefits.