The information in these booklets applies from January 1, 2017 to December 31, 2017.

One-Tier Formulary: MA Special Needs Plan 014

Our formulary PDFs are updated monthly. Read past Notices of Change.

Five-Tier Formulary: MA Pharmacy Plan 008, MA Pharmacy Plan 009, MA Extra Plan 010

Our formulary PDFs are updated monthly. Read prior formularies and changes.

The Comprehensive Formulary provides you with a list of drugs covered and their cost sharing tier as well as any additional requirements or limitations. The Formulary might change during the course of the year. You will need Adobe Acrobat Reader to view the PDF documents on this website. Download Adobe Acrobat Reader for free. Choose from the options below to get started.

For questions, contact:

Prospective Members: 1-800-944-1247

Current Members: 1-800-942-0247

TTY Relay: Dial 7-1-1

Hours: 8 a.m. to 8 p.m., 7 days a week

Pharmacy Directory

List of Covered Drugs and Criteria

The formulary and pharmacy network may change at any time. You will receive notice when necessary.