We review our formulary each month to make any necessary changes. A typical change is adding new generics that have come on the market.

Sometimes, we remove drugs from our formulary. Examples include if the U.S. Food and Drug Administration (FDA) views a drug as unsafe. Or if a drug maker removes the drug from the market.

Plans will let members know about any changes that may affect a drug they take.

Some drugs have rules you need to follow before we cover them. These include:

• Prior authorization: You or your doctor need our approval before we cover the drug.
• Step therapy: We require you to try another drug first before we cover your drug.
• Quantity limits: For certain drugs, we limit the amount you can get.

You and your doctor can request an exception to one of our coverage rules, including the ones listed above.

There may be times where you’re taking a drug that either isn’t on our formulary or has special rules before we cover it. Learn about our transition process to:

• See if you’re eligible for a short-term supply of medicine.
• Work with your doctor to switch to a new drug.
• Request an exception to continue your current drug.

Details about our 2023 transition process