​​Find Your Formulary (Drug List)
Large Group Plans
Information about prescription drug plans and a list of medications available to members in our large employer group (51+ employees) plans who have prescription drug coverage provided by Presbyterian Health Plan.
Health Insurance Exchange Metal Level Plans
Information about prescription drug plans and a list of medications available to members on our individual and family plans or on a small employer group (1-50 employees) plans. (Applies to both on and off exchange plans.)
Centennial Care Plans
Information about prescription drug plans and a list of medications available to members on our Centennial Care plan.
Medicare Advantage Plans
List of drugs approved by the Centers for Medicare and Medicaid Services (CMS) — that are covered by Presbyterian’s Medicare Advantage prescription drug plans.
Drug Formularies
Additional Pharmacy Information
Important forms and documents related to your Presbyterian health insurance plan can be found in Forms and Documents.
Forms and Documents
Find a Pharmacy Location
View the list of pharmacies available on Presbyterian health plans or login to your myPRES account. Note that some drugs are required to be obtained through a specialty pharmacy provider.
You can also login to myPRES and select
MyPharmacy for up to date locations.
Login to myPRES
What if my Drug is not covered?
You can request an exception.
You or your doctor can ask us to make an exception (prior authorization) to our coverage rules. We will work with your prescriber to get additional information to support your request. There are several types of exceptions that you can ask us to make.
- You can ask us to cover your drug even if it is not on our formulary.
- You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, we limit the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover more.
Refer to your member handbook for more information about exceptions and the prior authorization process.
How to request an exception.
To request an exception, you or your appointed representative should call the Presbyterian Customer Service Center at the number listed on the back your ID Card.
You, your doctor, or pharmacist can submit a request by fax or mail.
Fax:
Mail:
PHP Pharmacy Department
P.O. Box 27489
Albuquerque, NM 87125-7489
If you are a Medicare Advantage member, visit your plan specific website.
Covered Contraceptives
Women’s preventive services are mandated as part of the Affordable Care Act (ACA). Presbyterian follows all requirements set by the ACA, including those that impact your prescription drug coverage. Refer to your plan materials to see if your plan includes a Women’s Preventive Medication coverage feature.
Mail Service Pharmacy Benefit
Presbyterian offers mail-order prescriptions in partnership with OptumRx. Order up to a 90-day supply of maintenance drugs (as prescribed by your physician) and get free delivery to your home with OptumRx Mail Service.
If you are a Medicare Advantage member, visit your plan specific website.