Please note that the listing of a medication on our Prescription Drug List (PDL) does not guarantee coverage as certain medications are excluded due to benefit plan design limitations that are specific to members’ individual or group benefits.
The PDL is current at the time of release and is subject to change.
- Prescription medication coverage varies dependent on a member's plan. The fact that a medication is listed here does not guarantee coverage. For specific information regarding a member's benefits, please refer to the Certificate of Coverage and Summary of Benefits.
- Please note that certain prescription medications require precertification.
- For most New York (NY) and Connecticut (CT) employer groups, diabetic supplies, including oral prescription medications, will be subject to the applicable medical office visit cost share noted on the member's Summary of Benefits.
- For most New Jersey (NJ) employer groups that have purchased coverage for outpatient prescription drugs, diabetic prescription medications will be subject to the applicable prescription benefit cost share noted on the member's Summary of Benefits. For NJ employer groups that have not purchased coverage for outpatient prescription drugs, diabetic supplies will be subject to the applicable medical office visit cost share noted on the Member's Summary of Benefits.
- The copayment (cost share) for the medications on this list may vary by dosage form and strength.