The formularies below are prescription drug lists of brand-name and generic medications that have undergone careful review by a committee of prescribers and pharmacists. Medications on these lists are subject to plan parameters and changes made in accordance with our actively managed formulary. For specific coverage and limitations information, as well as details about your co-pay, please refer to your benefit plan documents or contact DixclosedRX Member Assistance.

The specialty drug formulary changes from time to time. To see if your prescription is covered under the plan, as well as the level of coverage, please contact DisclosedRX at 800-589-3340 or email info@disclosedrx.com