Prospect Portal -

Product:

Category:

one moment please...

Formulary Search

Formulary Name: PBM PROCARE FORMULARY

Drug Search:

one moment please...

PREFERRED:
Generic or brand Drug that will yield the lowest cost in copay to you and your plan.

Drug Name	Brand / Generic	Tier	Utilization Management Edits	Generic Equivalent

These drugs may have additional restrictions on coverage. Some examples include:

     Prior Authorization (PA) - You will need to get approval from your plan before you fill your prescriptions.

     Quantity Limits (QL) –Limits the quantity of medication that can be dispensed within a time period.

     Step Therapy (ST) - Your plan may require you to first try certain drugs to treat your medical condition before this drug is authorized.

Detailed information can be found in the comprehensive formulary document below or by contacting Pharmacy Member Services at the number listed on the back of your card.

Why are there no results found for the product I selected?

Preferred Only Show All

Drug Name	Generic Name	Preferred

Comprehensive Drug List
	MC-Rx 2022Q2a.pdf

NOTE: To successfully launch PDF files, please ensure you have installed the latest version of Adobe Reader.
Download Adobe Reader Now.

Search for a specific drug based on your pharmacy benefit plan. Determine whether it is a brand, generic, preferred or non-preferred drug, and what alternative equivalent drugs exist.

The most common reasons there are no results found for the drug you selected is that the drug is not covered under your closed formulary or it is available Over the Counter (OTC) and does not require a prescription.

Type the Generic Equivalent name in the drug search box for a complete listing of options for this Generic.

comprehensive drug list is a list of covered drugs selected by your plan. The drug list is available for print in a PDF format.

The Coverage Determination form is used to submit a request for review based on a denial of a prescription medication or for a request to provide coverage for a medication that is not currently available on your prescription plan. Please print the form and take it to your prescribing physician to complete and sign and fax to the Clinical Department for review.