Medication Formularies
Medicare Formulary
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)
- Last updated Jan 1, 2022