• the drug is medically necessary,
• the prescription is filled at a Healthy Advantage network pharmacy,
• and other plan rules are followed.

Can the formulary change?
We may add or remove drugs from the formulary during the year. Changes in the formulary may affect which drugs are covered and how much you will pay when filling your prescription. If we remove drugs from the formulary, or add prior authorizations, quantity limits and/or step therapy restrictions on a drug, and you are taking the drug affected by the change, we will notify you of the change at least 60 days before the date that the change becomes effective. However, if a drug is removed from our formulary because the drug has been recalled from the market, we will not give 60 days notice before removing the drug from the formulary. Instead, we will remove the drug from our formulary immediately and notify members about the change as soon as possible. For more information on covered drugs and how to fill your prescriptions, including obtaining prescriptions at out-of-network pharmacies and how to get a temporary supply of drugs as a new member (see transition policy), please review Section 2 of your Evidence of Coverage.

 The files below or in PDF format. ()

• Transition Policy
• Changes to the Formulary
• 2010 Prior Authorization Grid
• 2010 Step Therapy Grid
• 2010 Comprehensive Formulary

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