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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

2021 Senior Health Plan Utilization Management Criteria Documents
  Formulary Changes Prior Authorization Step Therapy Quantity Limits
JanuaryJanuary 2021 Formulary ChangesJanuary 2021 Prior Authorization Criteria - updated 12/23/2020January 2021 Step Therapy Criteria - updated 12/23/2020See comprehensive formulary for quantity limits.
FebruaryFebruary 2021 Formulary ChangesFebruary 2021 Prior Authorization CriteriaFebruary 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
MarchMarch 2021 Formulary ChangesMarch 2021 Prior Authorization Criteria - updated 3/11/2021March 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
AprilApril 2021 Formulary ChangesApril 2021 Prior Authorization CriteriaApril 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
MayMay 2021 Formulary ChangesMay 2021 Prior Authorization CriteriaMay 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
JuneJune 2021 Formulary ChangesJune 2021 Prior Authorization CriteriaJune 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
JulyJuly 2021 Formulary ChangesJuly 2021 Prior Authorization CriteriaJuly 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
AugustAugust 2021 Formulary ChangesAugust 2021 Prior Authorization CriteriaAugust 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.
SeptemberSeptember 2021 Formulary ChangesSeptember 2021 Prior Authorization CriteriaSeptember 2021 Step Therapy CriteriaSee comprehensive formulary for quantity limits.

HPMS Formulary ID: 00021203 Version 15
HPMS Formulary Approval Date: 8/24/2021
Updated: 09/2021



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