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List of Drugs (Formulary)

The formulary is a list of drugs that are covered by a health insurance plan. The list of drugs are covered as long as the drug is medically necessary. To get the drug covered fill it at a network pharmacy. You can also use the mail order program for maintenance drugs. Some coverage rules must be followed. Some drugs have limits for coverage.

The drugs on the formulary are chosen by drug plan and health experts.

The drugs are reviewed by a group of doctors and pharmacists who do not work for the plan. This group is called the Pharmacy and Therapeutics Committee.

The formulary does not have all drugs on it.

Some drugs are not a covered benefit, or are excluded. Some drugs are not qualified for clinical reasons. Other drugs are not on the list of drugs because they are too expensive.

IlliniCare Health contracts with pharmacies in your area. We must offer a certain number of drug stores. We offer more than what is required.

IlliniCare Health can add or remove drugs from our list of drugs during the year.

We will tell members 60 days before changes are made to the list of drugs. Changes mean adding or taking drugs off the list. Changing the number of pills per month or moving drugs to a different cost level are changes.

If a drug is viewed as unsafe by the Food and Drug Administration or the manufacturer of the drug, it will be taken from our list of drugs right away.


Last Updated: 02/08/2018