This page lists important information that your doctor uses when determining the most appropriate course of treatment for you. Formularies include many commonly prescribed medications, both brand name and generic. Check the Formulary List to see if your drug is covered. Prior authorization forms can be used by a prescriber, an enrollee, or the enrollee's representative to request a coverage determination for drugs not listed on the Formulary or for drugs that require a prior authorization in order to be covered.
Commercial Small Group and Large Group Plan Formularies
Health Insurance Exchange Metal Level Plan Formularies
Supplement Formulary Information
Medicare Advantage Formularies and Formulary Updates
Centennial Care Formularies
Centennial Care Provider Directories
Medication Therapy Management
Please be sure a prescription drug benefit is part of your specific coverage before consulting this list. If you do not know which list is correct, please contact the Presbyterian Customer Service Center at
1-800-356-2219 for assistance. TTY users may call
Coverage for some drugs may be limited to specific dosage forms and/or strengths. Your benefit design determines what is covered for you and what your copayment will be. Please refer to your benefit materials for your specific coverage information.
The medications listed on this Formulary/Preferred Drug List (PDL) are subject to change pursuant to the Formulary/PDL management activities of Presbyterian Health Plan and Presbyterian Insurance Company, Inc. (Presbyterian). This list is not all-inclusive nor does it imply a guarantee of coverage. In addition, coverage for some drugs listed may be limited to specific dosage forms and/or strengths. Substitution of a generic product for a brand-name drug is mandatory when a generic equivalent is available. If a member requests the brand-name drug in this situation, a pharmacy exception may be required and the member must pay the difference in cost between the generic and branded versions. Non-formulary medications are not considered for coverage unless trial and failure of Formulary alternatives are documented.