Coronavirus (COVID-19) testing and treatment coverage

Comprehensive Formulary

Use the links below to access the Comprehensive Formulary.


Abridged Formulary


Formulary Changes and Utilization Management Criteria

2020 CommunityCare Prescription Drug 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.
FebruaryFebruary 2020 Formulary ChangesFebruary 2020 Prior Authorization CriteriaFebruary 2020 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
MarchMarch 2020 Formulary ChangesMarch 2020 Prior Authorization CriteriaMarch 2020 Step Therapy CriteriaSee comprehensive formulary for quantity limits.

HPMS Formulary ID: 00020511 Version 8
HPMS Formulary Approval Date: 02/25/2020
Updated: 03/2020

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