1A Selectively Closed formulary provides access to generic, brand preferred and select brand nonpreferred medications. Under a Selectively Closed formulary, only select brand non-preferred drugs (non-formulary drugs) are covered unless approved via a Non-Formulary Consideration Process. The provider may request that coverage be granted when medically necessary. The Non-Formulary Consideration Process may require the trial and failure of 2 formulary alternatives (if 2 are available) prior to approval of the non-formulary medication. Approvals will be member-and drug-specific. Each unique non-formulary drug exception must be reviewed and approved separately.
2Indicates specialty medication.
3Impacted members will be notified prior to change.