A formulary is the list of generic and brand-name prescription drugs covered by your plan. Drugs that do not appear on the formulary are not covered.
The formulary will also tell you:
If you’re enrolled in a Medicare Advantage plan or if your health care coverage is provided by a large group employer, check your plan documents to determine which formulary covers prescription medications for your plan. Then select the link for that formulary below.
COMMERCIAL CLOSED COMPREHENSIVE FORMULARY
COMMERCIAL OPEN/INCENTIVE COMPREHENSIVE FORMULARY
ESSENTIAL HEALTHCARE REFORM (HCR) FORMULARY
If you’re enrolled in an Individual and Family or Small Group Affordable Care Act (ACA) or ICHRA health care plan, your plan type determines which formulary lists your covered prescription drugs. Use the information below to find the one that applies to you.
Individual and Family Affordable Care Act and ICHRA Plans
If you have an Individual or Family ACA plan—whether you purchased it directly from Highmark, through a state or federal marketplace, or through an Individual Coverage Health Reimbursement Arrangement (ICHRA)—your covered prescription drugs are listed in the Essential Formulary.
Small Group Affordable Care Act Plans
If you’re enrolled in a Small Group ACA plan, your covered prescription drugs may be listed in either the Essential or Comprehensive Formulary. To be sure, check your plan documents and choose the formulary that applies to your coverage.
Ask your doctor about prescribing medications on the formulary to make sure they are covered.
When you use in-network pharmacies, you get the most out of your coverage. You can search a pharmacy by entering your ZIP code or City, State.
