Ucare formulary 2024 - Benefits and prices (premiums, copays and coinsurance costs) vary from group to group. The service area includes the entire state of Minnesota and 26 Wisconsin counties. Learn more about Group Medicare plans or call 1-877-598-6574 toll free (TTY: 1-800-688-2534) 8 am – 5 pm, Monday – Friday.

 
of the drug covered per prescription or for a. defined period of time. For example, quantity limits apply to specialty drugs. Specialty. drugs are medications that may be used to treat complex and/or rare health conditions. and require special handling, administration or monitoring. Specialty drugs are typically. covered for a one-month supply.. Engage as gears crossword clue

UCare's MSHO and UCare Connect + Medicare List of Covered Drugs (Formulary) - Somali (PDF) Updated 12/1/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023.pharmacy network, and/or copayments/coinsurance may on change January 1, 2024, and from time to time during the year. What is the UCare Your Choice Plans Formulary? A formulary is a list of covered drugs selected by UCare Your Choice Plans in …UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 03/19/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer Service at 612 ...In today’s fast-paced world, busy families need a vehicle that can keep up with their demanding lifestyle. SUVs have long been a popular choice for families, offering ample space a...UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer Service at 612 ...Dec 1, 2023 · Tier 1. Generic drugs. $7 copay. Tier 1. Brand drugs. $25 copay. Notes: No co-pays for pregnant women, children under 21, members in hospice, members residing in a nursing home for 30+ days, or adult members of a federally-recognized American Indian tribe. No co-pays for anti-psychotic drugs. FORMULARY . The formulary is a complete list of your covered prescription drugs. It includes generic, brand name, and specialty drugs, as well as Preferred drugs that will …2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans ... Te UCare formulary is a list of generic and brand drugs that are covered by this plan(s). To be covered, the drug must be on our formulary. Te most current list of covered drugs can beThe Super Bowl is one of the most anticipated sporting events in the world, attracting millions of viewers and fans alike. Each year, a different city hosts this iconic event, and ...Formulary Change Notice (PDF) 3/1/2024. Diabetic Supplies List (PDF) 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) 4/1/2024. MSHO Part D Information. UCare Connect + Medicare Part D Information. What is the UCare Formulary? The UCare formulary is a list of generic and brand drugs that are covered by this plan(s). To be covered, the drug must be on our formulary. The most current list of covered drugs can be found on the UCare Individual & Family Plans formulary at . ucare.org. To be covered, you must fill your prescription at a network ... Download the complete Formulary or search the list of covered drugs below. Prior Authorization Criteria (PDF) Updated 12/1/2023. Diabetes Supply List (PDF) Updated 5/1/2023. Medical Injectable Authorization List (PDF) Updated 12/1/2023. Continuation of Therapy Prior Authorization Criteria (PDF)UCare Medicare Group Plans - Basic 2024 Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication is covered and what tier it is.The UCare formulary is a list of generic and brand drugs that are covered by this plan(s). To be covered, the drug must be on our formulary. The most current list of covered drugs can be found on the UCare Individual & Family Plans formulary at ucare.org. To be covered, you must fill your prescription at a network pharmacy. The Provider Directory …Jan 1, 2024 · UCare Connect 2024 Formulary (List of Covered Prescription and Over-the-Counter Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication is covered and ... Your guide for the rest of the year. Check out the member center to watch helpful videos, find important documents, contact customer service through your online member account and more. Thanks for being an EssentiaCare member and we look forward to helping you get the most out of your plan. Medicare member center.2024 UCare Medicare Plans (HMO-POS) and EssentiaCare (PPO) Formulary (List of Covered Drugs) l UCare Medicare Plans (HMO-POS) UCare Aware UCare Classic UCare Complete UCare Essentials Rx ... taking a drug on our 2024 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during … 6 2024 UCare Medicare Plans and EssentiaCare Comprehensive Formulary − If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand-name drug for you. If you’re dreaming of a vacation that combines breathtaking scenery, rich history, and unparalleled luxury, look no further than Mediterranean cruises in 2024. No trip to the Medit...Oct 1, 2023 · Individual & Family Plans Formulary (PDF) 5/1/2024: UCare Formulary Exception Criteria (PDF) 4/1/2024: Prior Authorization Criteria: 10/1/2023: Diabetic Supplies List ... This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service at 612-676-6526 or 1-833-951-3183 (this call is free) For all TTY users: 612-676-6810 or 1-800-688-2534 …2024 List of Covered Drugs (Formulary) l UCare's MSHO l UCare Connect + Medicare Introduction This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription ... 2024 UCare's MSHO and UCare Connect + Medicare Formulary 11. l a drug is removed from the market. Questions B3 and B6 below have …2024 UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans …The UCare formulary is a list of generic and brand drugs that are covered by this plan(s). To be covered, the drug must be on our formulary. The most current list of covered drugs can be found on the UCare Individual & Family Plans formulary at ucare.org. To be covered, you must fill your prescription at a network pharmacy. The Provider Directory …UCare Medicare Group Plans - High 2024 Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication is covered and what tier it is.Preferred generic drugs. $10 copay per 30-day supply; $20 copay for up to 90-day supply. Tier 2. Non-preferred generics. $20 copay per 30-day supply; $40 copay for up to 90-day supply. Tier 3. Preferred Brand drugs. $175 copay per prescription; $25 for a 30-day supply of insulin on the formulary; $25 for a 30-day supply of select diabetes drugs.UCare is a registered service mark of UCare Minnesota | ©2024 UCare Minnesota. All Rights Reserved.UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 03/19/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service ...Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List (PDF) Updated 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023.1/1/2024. Diabetes Supply List (PDF) 5/1/2023. Medical Injectable Authorization List (PDF) 4/1/2024. Continuation of Therapy Prior Authorization Criteria (PDF) Non-Preferred Drug Prior Authorization Criteria (PDF) Medication Therapy Management (MTM) - available at no additional cost to members with chronic health conditions who take multiple ...Care Type: UCare Connect + Medicare 2024 Connect+ Medicare | 07.25.23 ... Keep your costs low by making sure your prescription drugs are on UCare’s drug list (also called a formulary). You can always check the drug list at search.ucare.org. Select “Drug List” from the menu at the top of the page and choose your specific plan from the “Pick your plan” …Prepaid Medical Assistance Program (PMAP) 2023 Formulary (List of Covered Prescription and Over-the-Counter Drugs) Download the complete Formulary or search the list of covered drugs below. Prior Authorization Criteria (PDF) Updated 12/1/2023. Diabetes Supply List (PDF) Updated 5/1/2023.80% of covered charges for emergency care while traveling outside U.S. First three pints of blood; 100% of Part B charges for covered immunizations and routine screenings; ... Download the 2024 UCare Medicare Supplement Plans comparison chart. Download comparison chart. people powered health plans UCare is powered by the hardest …QL Quantity Limit Tere are limits to the amount of drug covered per fll 2024 UCare Individual & Family Plans Comprehensive Formulary 5. SP Specialty Drug Specialty drugs that require you to fll your prescription through Fairview Specialty Pharmacy. Specialty drugs are injectable or oral drugs that ofen require special handling or monitoring by a …January 2024 2024 EMPIRE PLAN ... If you continue using any of the drugs listed, you will be required to pay the full cost of non-formulary products that are excluded from coverage unless a request for a medical exception is approved. New prescription drug products may be subject to exclusion upon release to the market. If you are currently using any of the …Oct 1, 2023 · UCare Formulary Exception Criteria (PDF) 4/1/2024. Prior Authorization Criteria. 10/1/2023. Diabetic Supplies List (PDF) 5/1/2023. Medical Injectable Drug Authorization List (PDF) 4/1/2024. Medication Therapy Management (MTM) – available at no additional cost to members with chronic health conditions who take multiple medicines. Mar 1, 2024 · UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 02/20/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer Service at 612 ... Are you dreaming of embarking on an unforgettable journey along the scenic rivers of Europe? Look no further than a Vikings River Cruise in 2024. One of the main attractions of a V...Minneapolis-based UCare posted an operating loss of $82.1 million last year due in part to greater use of health care services. 2023 figure excludes $100 million set …This Prescription Drug List (PDL) is accurate as of January 1, 2024 and is subject to change after this date. This PDL applies to members of our UnitedHealthcare, River Valley, Oxford, and Student Resources medical plans with a pharmacy benefit subject to the Traditional 3-Tier PDL. Your estimated coverage and copayment/coinsurance may vary ...The Honda Ridgeline is an iconic pickup truck that has been around since 2005. It has been a favorite among drivers for its reliable performance, spacious interior, and great fuel ...QL Quantity Limit Tere are limits to the amount of drug covered per fll 2024 UCare Individual & Family Plans Comprehensive Formulary 5. SP Specialty Drug Specialty drugs that require you to fll your prescription through Fairview Specialty Pharmacy. Specialty drugs are injectable or oral drugs that ofen require special handling or monitoring by a … UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 03/19/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer Service at 612 ... Tier 1. Generic drugs. $7 copay. Tier 1. Brand drugs. $25 copay. Notes: No co-pays for pregnant women, children under 21, members in hospice, members residing in a nursing home for 30+ days, or adult members of a federally-recognized American Indian tribe. No co-pays for anti-psychotic drugs.Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List (PDF) Updated 8/1/2023. Part B Medical Injectable Drug Authorization List (PDF) Updated 11/28/2023.If you’re dreaming of a vacation that combines breathtaking scenery, rich history, and unparalleled luxury, look no further than Mediterranean cruises in 2024. No trip to the Medit...UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) Updated 3/1/2023. UCare Formulary Exception Criteria (PDF) Updated 10/1/2022. Formulary Change Notice (PDF) Updated 8/1/2023. Diabetic Supply List …FORMULARY . The formulary is a complete list of your covered prescription drugs. It includes generic, brand name, and specialty drugs, as well as Preferred drugs that will …Are you already dreaming about your next vacation in 2024? With the new year just around the corner, it’s never too early to start planning. Whether you’re a beach lover, an advent...ANTIRHEUMATIC ANTIMETABOLITES. GOLD COMPOUNDS. INTERLEUKIN-1 BLOCKERS. INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA) INTERLEUKIN …Princess Cruises is renowned for providing unforgettable experiences and luxurious journeys to some of the world’s most breathtaking destinations. As we look forward to the year 20...2024 Evidence of Coverage for UCare Aware 13 Chapter 1. Getting started as a member SECTION 1 Introduction Section 1.1 You are enrolled in UCare Aware, which is a Medicare HMO Point-of-Service Plan You are covered by Medicare, and you have chosen to get your Medicare health care and your prescription drug coverage through our plan, UCare Aware.Upscale river cruise line AmaWaterways has announced an unusually long voyage that includes stops in 15 countries in Europe. How long is too long for a European river cruise? AmaWa...search list of covered drugs; health and wellness. rewards and incentives; benefits and perks; healthy benefits+ visa® card; special programs and support; preventive care; classes and education; health information and tips; all health and wellness topics; member center; plan documentsThis formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer Service at 612-676-6526 or 1-833-951-3183 (this call is free) For all TTY users: 612-676-6810 or 1-800-688-2534 (this ...2024 List of Covered Drugs (Formulary) l UCare's MSHO l UCare Connect + Medicare Introduction This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription drugs and over-the-counter (OTC) drugs are covered by UCare's MSHO and UCare Connect + Medicare. UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 03/19/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer Service at 612 ... Preferred generic drugs. $15 copay per prescription; $30 copay for up to 90-day supply. Tier 2. Non-preferred generics. $20 copay per 30-day supply; $40 copay for up to 90-day supply. Tier 3. Preferred Brand drugs. 20% coinsurance after deductible; $25 for a 30-day supply of insulin on the formulary; $25 for a 30-day supply of select diabetes ...A list of covered drugs includes the prescription drugs covered by UCare. Te drugs on the list are selected by UCare with the help of a team of doctors and pharmacists. UCare will generally cover the drugs listed in the list of covered drugs as long as the drug is medically necessary, the ... formulary. 8 2024 Medicaid Formulary . What is a Preferred Drug …1-877-523-1515 toll-free. TTY users call 1-800-688-2534. 8 am – 8 pm, 7 days a week. This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.Download the complete Formulary or search the list of covered drugs below. UCare Your Choice Formulary (List of Covered Drugs) (PDF) Updated 12/1/2023. UCare Your Choice Formulary (List of Covered Drugs) - Spanish (PDF) Updated 12/12/2023. Prior Authorization Criteria (PDF) Updated 12/1/2023. Step Therapy Criteria (PDF) …UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 02/20/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans Customer Service at 612 ...MinnesotaCare 2024 Formulary (List of Covered Prescription and Over-the-Counter Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication …2024 UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 04/18/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Medicare Group Plans …2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans l UCare Individual & Family Plans with M Health Fairview This formulary may change throughout the year. Please visit ucare.org or call UCare Customer Service for the most current information.The 2024 Subaru Crosstrek is an impressive compact SUV that offers a blend of style, versatility, and performance. One of the most exciting aspects of this vehicle is the wide rang...UCare's Minnesota Senior Health Options (MSHO) (HMO D-SNP): 2024 Summary of Benefits Introduction This document is a brief summary of the benefits and services covered by UCare's MSHO. It includes answers to frequently asked questions, important contact information, an overview of benefits andUCare Medicare Plans with M Health Fairview & North Memorial | UCare Your Choice Plans 2024 Comprehensive Formularies: Formulary pages for UCare Medicare Plans, EssentiaCare, UCare Medicare with Fairview & North Memorial, UCare Advocate PlansIndividual & Family Plans UCare Core and UCare M Health Fairview Core 2024 Formulary (List of Covered Drugs) Download the complete Formulary or search …ANTIRHEUMATIC ANTIMETABOLITES. GOLD COMPOUNDS. INTERLEUKIN-1 BLOCKERS. INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA) INTERLEUKIN-1BETA BLOCKERS. INTERLEUKIN-6 RECEPTOR INHIBITORS. NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) PHOSPHODIESTERASE 4 (PDE4) …2024 Evidence of Coverage for UCare Complete Metro 13 Chapter 1. Getting started as a member SECTION 1 Introduction Section 1.1 You are enrolled in UCare Complete, which is a Medicare HMO Point-of-Service Plan You are covered by Medicare, and you have chosen to get your Medicare health care and yourToyota has long been a leader in the automotive industry, and the all-new Toyota Grand Highlander 2024 is no exception. This full-size SUV is packed with features that make it a gr...1-877-523-1515 toll-free. TTY users call 1-800-688-2534. 8 am – 8 pm, 7 days a week. This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.Individual & Family Plans formulary (list of covered drugs) Select your plan: ... UCare is a registered service mark of UCare Minnesota | ©2024 UCare Minnesota. All ...you will see the page number where you can fnd coverage information within the formulary. 4 2024 UCare Individual & Family Plans Comprehensive Formulary . Tiers and limitations for prescription drugs Te numbers in the Tier column on the formulary indicates the cost share for the medication. $0 Tier Preventive drugs that may be eligible …Te enclosed formulary is current as of 01/23/2024. To get updated information about the drugs covered by UCare Your Choice Plans, please contact us. Our contact information …2024 List of Covered Drugs (Formulary) l UCare's MSHO l UCare Connect + Medicare Introduction This document is called the List of Covered Drugs (also known as the Drug List). It tells you which prescription ... 2024 UCare's MSHO and UCare Connect + Medicare Formulary 11. l a drug is removed from the market. Questions B3 and B6 below have …6 2024 UCare Medicare Plans and EssentiaCare Comprehensive Formulary − If we make such a change, you or your prescriber can ask us to make an exception and continue to cover the brand-name drug for you.2024. UCare Individual & Family Plans Formulary (List of Covered Drugs) lUCare Individual & Family Plans. lUCare Individual & Family Plans with M Health Fairview. This formulary may change throughout the year. Please visit ucare.orgor call UCare Customer Service for the most current information.Deductible does not apply to this tier. $12 copay. $3 copay. Available for two preferred copays. Tier 2. Generic drugs. $480. $20 copay. $10 copay.

Summary of Important Costs for 2024 The table below compares the 2023 costs and 2024 costs for UCare Essentials Rx in several important areas. Please note this is only a summary of costs. Cost 2023 (this year) 2024 (next year) Monthly plan premium* * Your premium may be higher or lower than this amount. Refer to Section 1.1 for details. …. How long does life360 keep history

ucare formulary 2024

2024 UCare Medicare Group Plans Formulary (List of Covered Drugs) l UCare Medicare Group Plans (HMO-POS) This formulary was updated on 09/29/2023. PLEASE READ: …The UCare formulary is a list of generic and brand drugs that are covered by this plan(s). To be covered, the drug must be on our formulary. The most current list of covered drugs can be found on the UCare Individual & Family Plans formulary at . ucare.org. To be covered, you must fill your prescription at a network pharmacy. The Provider Directory …2024 UCare's Minnesota Senior Health Options Summary of Benefits. This document is a brief summary of the benefits and services covered by UCare's MSHO. It includes. answers to frequently asked questions, important contact information, an overview of benefits and. services offered, and information about your rights as a member of UCare's MSHO.ANTIRHEUMATIC ANTIMETABOLITES. GOLD COMPOUNDS. INTERLEUKIN-1 BLOCKERS. INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA) INTERLEUKIN-1BETA BLOCKERS. INTERLEUKIN-6 RECEPTOR INHIBITORS. NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) PHOSPHODIESTERASE 4 (PDE4) …2024 Comprehensive Formularies: Formulary pages for UCare Medicare Plans, EssentiaCare, UCare Medicare with Fairview & North Memorial, UCare Advocate Plans. UCare Your Choice Formulary web page. UCare Medicare-Group Formulary web pageUCare Medicare Group Plans - State of Minnesota 2024 Formulary (List of Covered Drugs) Download the complete Formulary or search the list of covered drugs below. Follow these steps to see the coverage and cost of your medication. Find out what tier your medication is. Use the drug search tool below to see whether your medication is covered and ...UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 01/23/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer …UCare Your Choice Plans (PPO) Formulary (List of Covered Drugs) l UCare Your Choice l UCare Your Choice Plus This formulary was updated on 03/19/2024. PLEASE READ: This document contains information about the drugs we cover in these plans. For more recent information or other questions, please contact: UCare Your Choice Plans Customer …2024 UCare Individual & Family Plans Formulary (List of Covered Drugs) l UCare Individual & Family Plans l UCare Individual & Family Plans with M Health Fairview This formulary may change throughout the year. Please visit ucare.org or call UCare Customer Service for the most current information.2024 UCare Individual & Family Plans. Here’s a summary of our plans. On MNsure, you'll find more plan details and an estimate of your subsidy based on your household details. ... Fully covered in-network preventive care and money saving health and wellness perks included with your plan; Decide between UCare’s broad network or our more focused …drug may be covered if it is determined to be medically necessary. About this PDL Where differences exist between this PDL and your benefit plan documents, the benefit plan documents rule. This PDL is not a complete list of medications, and not all medications listed may be covered by your plan. Please look at the benefit plan.

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