Member pharmacy benefits

The drug list, also called a formulary, is a list of prescription medicines your plan covers. It includes hundreds of brand-name and generic drugs approved by the U.S. Food & Drug Administration (FDA).

The drugs are listed in alphabetical order based on the name of their drug class, also called therapeutic class. You can search the PDF drug list by typing in the name of the drug you’re looking for.

The notes column will tell you if you need preapproval before you can take the drug (called prior authorization or PA), or if you need to try other drugs first for your treatment (called step therapy or ST).

Your plan’s network includes over 67,000 pharmacies nationwide, with two levels of coverage:

• Level 1: Your plan’s network has nearly 26,000 preferred pharmacies, including chains like CVS, Target, Kroger, Walmart, Albertson’s, Strategic Health Alliance, Giant Eagle, and Costco. Preferred pharmacies are those we work with to help you save on medication costs, including copay and co-insurance.
• Level 2: You can also fill prescriptions at any of the plan’s 40,000+ non-preferred Level 2 pharmacies, but you may pay more. If you regularly take medication for ongoing conditions like asthma, diabetes, or high cholesterol, you will need to set up 90-day supplies at a pharmacy in the Rx 90 network, including CVS retail or through home delivery. This is a requirement, but it also helps you save time and money on refills.

Home Delivery

If there are medications you take regularly, you can save time and money with our home delivery service. CarelonRx Pharmacy for members and Carelon Rx Mail for employers and brokers will deliver up to 90-day supplies with free standard shipping.

Learn more about 90-day delivery.

Specialty Pharmacy

If you have a health condition that requires specialty medicine, such as those you take by injection or infusion, or that need special handling, you will need to order through CarelonRx Specialty Pharmacy. You may also choose other in-network specialty pharmacies.

To view a list of covered specialty drugs that require a network specialty pharmacy, please visit our Drug List, and select the Exclusive Specialty Drug List.

Yes, this is a complete listing of all the drugs on the drug list. But it’s possible a drug(s) on this list may not be covered, depending on your plan’s design. Your coverage has limitations and exclusions, which means there are certain conditions that determine what’s covered by your plan and what isn’t.

To find out more, read your Certificate/Evidence of Coverage or your Summary Plan Description, which you got when you signed up for your plan.