Coronavirus (COVID-19) testing and treatment coverage

Comprehensive Formulary

Use the links below to access the Senior Health Plan Comprehensive Formulary.


Abridged Formulary


Extended Day Supply for Tier 1 and 2 drugs (100 days or more)

Enjoy the convenience of extended supplies on select medications (100 days or more) and pay $0 copay.


Formulary Changes and Utilization Management Criteria

2020 Senior Health 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: 00020509 Version 7
HPMS Formulary Approval Date: 02/25/2020
Updated: 03/2020



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