Medication Formularies

Medicare Formulary

• For Medicare Information, click here

Grandfathered Commercial Plans

Select Plan to view:

• 2022 Prescription Drug Formulary (PDF) | Drug Search | Prior Authorization Criteria
• Medical Pharmacy Formulary (PDF) | Drug Search| Prior Authorization Criteria
• FHCP Pharmacy Discount Drug List

Non-Grandfathered Commercial Plans

• 2022 Prescription Drug Formulary (PDF) | Drug Search | Prior Authorization Criteria
• Medical Pharmacy Formulary (PDF) | Drug Search| Prior Authorization Criteria
• FHCP Pharmacy Discount Drug List

Federal Exchange Plans

• 2022 Prescription Drug Formulary (PDF) | Drug Search | Prior Authorization Criteria
• Medical Pharmacy Formulary (PDF) | Drug Search | Prior Authorization Criteria
• FHCP Pharmacy Discount Drug List

Prior Authorization Form

• FHCP Prior Authorization Medication Form (must be completed by physician)

Contraception Appliance Order Forms

• Caremark Implanon Nexplanon Form
• Kyleena, Mirena and Skyla Request
• PARAGARD 41328 Patient Referral and Authorization Form

Medication Prior Authorization

• FHCP Prior Authorization Medication Policy and Drug List
• FHCP Prior Authorization Medication Form (must be completed by physician)