Health Cooperative Strategies

What is a Formulary?

A formulary is a list of drugs that are covered by your pharmacy benefits. It helps you understand the medications that are included in your plan and their copay tier. This list is reviewed regularly by our Pharmacy & Therapeutics (P&T) Committee to make sure it includes safe, effective, and affordable treatment options. For more information on how to fill your prescriptions, please review your plan documents.

What are Drug Tiers?

Tier 1 – Preferred Generics: These are low-cost, commonly used generic drugs. They are usually the most affordable option.

Tier 2 – Non-Preferred Generics / Preferred Brands: These are generally moderately priced medications. You will see some brand-name and higher-cost generic drugs on this tier.

Tier 3 – Non-Preferred Brands: These are higher-cost drugs, often brand-name medications that are not preferred. Lower-cost alternatives to the drugs in Tier 3 can usually be found in Tiers 1 or 2.

Printable Files

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How to Search For Drugs

• Use the alphabetical list to search by the first letter of your medication.
• Search by typing part of the generic (chemical) and brand (trade) names.
• Search by selecting the therapeutic class of the medication you are looking for.

How to Request a Formulary Exception

Formulary exclusions, also known as non-formulary medications, occur when a medication is not included on your plan’s formulary. These exclusions can be appealed. Plan-level exclusions happen when your health plan does not cover a specific medication, medication class, or diagnosis. These types of exclusions are not appealable. To appeal a denial for a non-formulary medication, your provider must submit either a formulary exception form or a letter of medical necessity. This documentation should explain why the requested medication is medically necessary compared to all available formulary alternatives. This form can be found on our website: DisclosedRx.com