Comprehensive Formulary

Use the links below to access the Advantage Medicare Plan Comprehensive Formulary.


Abridged Formulary


Formulary Changes and Utilization Management Criteria

2020 Advantage Medicare Plan Utilization Management Criteria Documents
  Formulary Changes Prior Authorization Step Therapy Quantity Limits
JanuaryJanuary 2020 Formulary ChangesJanuary 2020 Prior Authorization Criteria - updated 11/27/2019January 2020 Step Therapy Criteria - updated 11/4/2019See comprehensive formulary for quantity limits.

HPMS Formulary ID: 00020510 Version 5
HPMS Formulary Approval Date: 10/06/2019
Updated: 11/2019



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