| Formulary |
 |
Approved for coverage if included under a member's benefit. |
| Non-Formulary |
 |
Specific medications that are not covered, but other medications in the same class are available. |
| Generic is Formulary, Brand is Non-Formulary |
 |
Symbol indicates that a generic is available. Data has not been published to show brand name versions are more effective or have fewer side effects compared to generics. In most cases, the generic is covered and the brand is not covered. |
| Prior Authorization |
 |
Approved for coverage only after certain conditions are met. See Prior Authorization FAQs. Click here for commonly used prior authorization forms. |
| Quantity Limit |
 |
Limits the amount of drug that a member may receive in a certain period of time based on published guidelines. |
| Step Therapy |
 |
Approved for coverage automatically if there is a record that the member has already tried the preferred medication. If there is no record, clinical information will need to be supplied by the prescriber. See Step Therapy FAQs. |
| Notes |
 |
The notes contain information on criteria or coverage limits for certain drugs. |
