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About the Formulary

We may add or remove drugs from our formulary during the year. 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). No changes to the formulary at this time. 

Exceptions to the Formulary

You can ask Network Health Medicare Advantage Plans to make an exception to our prescription drug restrictions. To do so, you should submit a statement from your physician supporting your request. You can call us to ask for an exception, submit your request by using the link below or fax or mail the form found at the link below.

Submit a Request for a Drug Coverage Determination

What You Pay

When you find your drug, it will be listed with a tier number. This is the cost category your drug belongs to. The tier number a drug is on determines what you pay for the drug, and the higher the tier, the more you pay. Our plans have five drug tiers. Within each tier, you pay less when you use a preferred pharmacy. See Drug Costs for copayment amounts for each of our plans.