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Caremark formulary 2021

caremark formulary 2021 What is not changing? You will also be able to continue to use the current network of Participating Pharmacies. January 2021 PEBTF Drug List The PEBTF Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Understanding the Formulary How to use the Abbreviated Formulary Abbreviated Formulary Managed Not Covered” Drugs Excluded Drug List YOUR PHARMACY BENEFIT The Blue Cross and Blue Shield Service Benefit Plan works . m. Machine Readable Format of MI Formulary. ” Drug List (Formulary) 03/01/2021 . on our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 coverage year except as described above. caremark. to 6 p. Administrator: CVS Caremark Website: www. 5x copay is only applicable for three-month mail order fills from CVS Mail Order. However, they are not complete lists of all prescription drugs covered under The Empire Plan. 2021 Comprehensive Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN . We may require providers to submit information to us to explain why a specific medication and/or a certain amount of a medication is needed. ©2021 CVS Caremark. The enclosed formulary is current as of January 1, 2021. For more recent information or other questions, CVS Health Corp. 13% off Offer Details: Change to the brand-name medication: The generic medications in the letter you received will no longer be covered by the formulary with CVS Caremark after April 1, 2021. Specialty drugs must be dispensed by the Caremark specialty pharmacy (1-866-387-2573). HPMS Approved Formulary File Submission ID 21121, Version 11 This formulary was updated on 03/01/2021. *2. The new 2021 exclusions, as researched by PHSL, are as follows: January 2021 Updated 12/15/2020 2021 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS Caremark® The Empire Plan Flexible Formulary is a guide within select therapeutic categories for enrollees and health care providers. List is subject to change. Medications not listed on the formulary are considered to be non-formulary and are subject to prior authorization. The PBM states that only 0. It shows the drugs we cover, the tier a drug is on, any limits or requirements and mail order availability. January 2021 Updated 11/01/2020 The Advanced Control Formulary™ is a guide within select therapeutic categories for clients, plan members and health care providers. CVS/caremark is a trademark of CVSHealth Inc. Formulary (covered drug list) Formulary updates: 2021 formulary (Advantage) Advantage formulary. The Customer Care phone number for CVS/caremark is 877-232-8128. Provider Directory. For an updated formulary, please contact us. The Plan’s Pharmacy Benefit Manager, CVS Caremark, is another valuable resource as you navigate through your decisions. ACA Covered under the Affordable Healthcare Act -no member cost share NF Non -Formulary PA Prior authorization required PD Preventive Drug QL Quant ity its Apply January 2021 Products distributed by CVS Specialty Pharmacy, as well as products covered by a plan member’s prescription benefit plan may change from time to time CVS Caremark systems capabilities will provide eligible beneficiaries a temporary supply of non-formulary Part D drugs in order to accommodate the immediate needs of an enrollee, as well as to allow the plan and/or the enrollee sufficient time to work with the prescriber to make an appropriate switch to a therapeutically equivalent medication 2021 Formulary Quick Reference Guide (PDF) Member Handbook Materials. HPMS Approved Formulary File Submission 00021410, Version 9 . m. Generics should be considered the first line of For specific information, visit Caremark. m. NY Individual & Small Group - After Deductible. to 6 p. February 2021 - MI Medicaid Formulary Updates. CVS Caremark currently processes prescription claims from participating pharmacies, mail order claims and paper claims filed by participants for approximately 103 million members across the country. Based on PHSL’s calculations, ESI leads the way with 117 new formulary exclusions. For more recent information or other questions, please contact SilverScript Customer Care at 1-866-275-5253, 24 hours a day, 7 days a week. New Cigna website information – myCigna. This document includes a list of the drugs (formulary) for our plan which is current as of January 1, 2021. What is not changing? You will also be able to continue to use the current network of Participating Pharmacies. This formulary was updated on 08/17/2020. The formulary is subject to change and all previous versions of the formulary are no Caremark. Cleveland Clinic Health Benefit Program Prescription Drug Benefit January 2021 2021 Formulary-Last updated 03/24/2021. Thursday, February 04, 2021 CMU Recognized as Breastfeeding-Friendly Employer. For information on the formulary or specific questions on covered drugs, please call CVS Caremark at 1-855-305-3028. View CVS Caremark’s updated formulary . For more recent information or other questions, please contact the MVP Medicaid Customer Care Center. This formulary applies to members of our UnitedHealthcare West HMO medical plans with a pharmacy benefit. deems a drug on our formulary to be unsafe, or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. Also applies to small group employers with 100 employees or less. CVS Caremark CMO find the formulary that applies to you. The Formu lary, pharmacy Formulary 3; Formulary 3 (5-Tier: generic, preferred brand, non-preferred brand, preferred brand specialty, non-preferred brand specialty) Formulary 3 Preferred Drug List. Understanding your formulary – the list of generic and brand name prescription drugs covered by your plan – is essential to keeping your out-of-pocket prescription drug costs low. The formulary or drug list is regularly updated throughout the year, on a quarterly basis. Oral Oncology Drug List - Effective Jan 1, 2021 Underlying principles of the CVS Caremark Formulary Development and Management Process include the following: CVS Caremark is committed to providing a clinically appropriate formulary. Formulary lookup and preventive drug lists for Premium, Core NH, and Value formularies. Your 2021 Premium Standard Formulary Effective January 1, 2021. Pharmacy Clinical Policy Bulletins for all other formulary plans are available by calling the number on the back of the member’s ID card. -- (BUSINESS WIRE)--Beginning January 1, 2021 Bioventus, a global leader in Innovations For Active Healing, will gain preferred access Search the 2021 drug lists online Individual HealthPartners Medicare plans. The State Group Health Plan will transition from Express Scripts to VS aremark for active employees and non-Medicare retirees on July 1, 2021. CVS/Caremark January 1, 2021 Formulary Update. Monday, February 15, 2021 $100 Referral Bonus for Tartan Testing Program. April 2021 2021 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS Caremark® The Empire Plan Flexible Formulary is a guide within select therapeutic categories for enrollees and health care providers. You must generally use network pharmacies to use your prescription drug benefit. com and click “Choose your pharmacy. • Look up possible lower-cost medication alternatives. April 2021 Value Formulary Quick Reference List The Value Formulary Quick Reference List is not an all-inclusive list but represents a summary of prescribed medications within select therapeutic categories. com before using the tool, your plan design Caremark. Anthem Blue Cross and Blue Shield – Medicare. com. CDPHP Commercial Clinical Formulary-1 2021 NON-DISCRIMINATION/MULTI-LANGUAGE INTERPRETER SERVICES: APPLIES TO MEMBERS/ENROLLEES ONLY Discrimination is Against the Law Capital District Physicians’ Health Plan, Inc. How much will you pay? Compare your plan options below for Individual or Small Group plans sold directly from MVP Health Care® or through Vermont Health Connect. This search of a sample plan returns the amount paid per prescription with the co-pay tier structure, deductibles and out-of-pocket maximums described below. Your Summary of Benefits tells you the drug costs for tiers. NY Individual & Small Group - Before Deductible. 13% off Offer Details: necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non-formulary prescription request criteria. 57 drugs removed; six drugs added back** One drug added to Tier 1 strategy Formulary last updated: 03/29/2021 Drugs noted as “Select Insulin” are covered under Part D Senior Savings Model Program. All individual HealthPartners Medicare plans use Formulary I. Some drugs require prior authorization (PA). Customer Service Post-Enrollment: 1-833-244-3888. 2021 Standard Control Formulary Removals and Updates Starting January 1, 2021, you can also get a copy of the most current CVS Caremark formulary on Caremark. Effective 01-01-2021 This report highlights all changes (additions, deletions, and removals) to the CVS Caremark ® Advanced Control Formulary. 2021 Standard Control Formulary Changes* The changes we are making effective January 1, 2021 will help ensure our formulary strategies remain the most impactful tool for clients seeking to better manage costs. Click Here to download a printable PDF- Control Specialty Formulary Exclusions effective 1/1/2021. Behavioral Health Comprehensive Formulary – effective 4/1/2021 Crisis Medication List – e ffective 4/1/2021 To request a printed copy of our Formularies, call Member Services toll-free at 1-800-322-8670, Monday through Friday (except holidays), 6 a. Download/Print in Alphabetic Order 2021 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. Viva Medicare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Viva Medicare network pharmacy, and other plan rules are followed. Machine Readable Format Formulary Definition File. m. United Healthcare Commercial. Please refer to the CVS Caremark® Performance Drug List for preferred medications options that are available. For the most current list of covered medications or if you have questions: Call the number on your member ID card. * Includes the Empire Plan Flexible Formulary and Advanced Flexible Formulary. Exclusion Drug List. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. Please continue reading for additional information to help you prepare for the transition to CVS Caremark. 13% off Offer Details: Change to the brand-name medication: The generic medications in the letter you received will no longer be covered by the formulary with CVS Caremark after April 1, 2021. Formulary 2 Updates Effective February 3, 2021 The following drug products were reviewed and acted upon by the CDPHP Pharmacy and Therapeutics Committee for The Formulary 2. 's Caremark will exclude 57 medications from its 2021 formulary and add six back. ©2021 CVS Caremark. CVS also excluded drugs from new categories such as acromegaly, oncology, gastrointestinal, ophthalmic, Parkinson’s disease, cardiovascular and so on. com on or after January 1, 2021 to add your preferred payment method to your mail order prescriptions. 2021 Drug Lists and Other Information. mycpchembenefits. 2021 Medicare Plans 2021 Medicare Assured Plans Formulary Medications Formulary Medications - Gateway Health dropdown expander Formulary Medications 2021 Basics; Printed Formulary Members can complete this form to order prescriptions from CVS Caremark Mail Service Pharmacy, WellCare's preferred mail-order pharmacy, call CVS Caremark at 1-800-240-9623 starting September 21, 2020. Access Fingertip now! This drug list is reviewed at least once per month and was last updated on 3/1/2021. Or, request a new 90-day prescription at Caremark. Download/Print by Therapeutic Class . April 2021 2021 EMPIRE PLAN ADVANCED FLEXIBLE FORMULARY DRUG LIST Administered by CVS Caremark® The Empire Plan Advanced Flexible Formulary is a guide within select therapeutic categories for enrollees and health care providers. Prescription drug prior authorization or step therapy exception request form (PDF, 1. Cvs Caremark Medicare Formulary 2021 Health. • Look up possible lower-cost medication alternatives. This means these drugswill remain available at the same cost-sharing and with no new restrictions for those members March 1, 2021. mycpchembenefits. com and click “Choose your pharmacy. with Pharmacy Benefit Managers (PBMs) to administer your pharmacy benefit. Overall, the 2021 changes include 57 drug exclusions, six drugs added back, and one drug added to the Tier 1 strategy. January 2021 Updated Quarterly Specialty and non-specialty products distributed by CVS Specialty, as well as products covered by a member’s prescription or medical benefit plan, may Formulary 1 and 5 2021 PDL Updates Effective January 1, 2021 The following drug products were reviewed and acted upon by the CDPHP Pharmacy and Therapeutics Committee for The Formulary 1and 5 . Most changes throughout the year will have a positive impact on customers such as adding new drugs to our drug list, removing restrictions, or moving a medication to a lower cost-sharing tier. These tools include information based on the 2020 formulary and are subject to change prior to January 1, 2021. com under “Health & Wellness,” then “Health. Brand-Name Drugs 2021 Medicare Basics; Printed Formulary Members can complete this form to order prescriptions from CVS Caremark Mail Service Pharmacy, WellCare's preferred Effective April 1, 2021, Caremark will replace OptumRx as your PBM and will administer your prescription drug benefit on the Fund’s behalf. Choosing drugs that are listed on the formulary can help you save money on your drug copayments. Formulary Drug Table - Effective Jan 1, 2021. Influenza or 'flu' is a viral respiratory illness, mainly spread by droplets made when people with flu cough, sneeze or talk. lower for formulary generic and formulary brand-name drugs. S. and Wednesday from 10 a. This useful reference tool can assist medical providers in selecting therapeutically appropriate and cost-effective products for their patients. To help you determine what your out-of-pocket cost will be, please read Drug categories. CVS Caremark excluded 57 drugs from its standard formulary in 2021 compared to 100 drugs in 2020. CVS Caremark has a broad pharmacy network. For specific information, visit Caremark. Why are generic medications so widely used? The U. ADAP formulary HIV AIDS. To locate a participating pharmacy go to www. For more recent information or other questions, please contact Cigna Customer Service, at . MedStar Family Choice is pleased to provide the 2021 MedStar Family Choice - Maryland HealthChoice Prescribing Guide to be used when prescribing for patients covered by the pharmacy plan offered by MedStar Family Choice. 1-800-852-7826 (TTY: 1-800-662-1220) Monday-Friday, 8 am - 6 pm Eastern Time Visit mvphealthcare. com antes de usar la herramienta, la CVS Caremark and Express Scripts formulary changes The two largest PBMs, CVS Caremark and Express Scripts, manage pharmacy benefits for more than 200 million Americans. Pharma's most trusted formulary data in a free, interactive lookup tool. If you have any questions about coverage of a certain product, please contact us at 1-800-533-1995. 1-800-668-3813 or, for TTY users, 711, 7 days a week, 8 a. Start the activation process by providing your CVS Caremark member ID number and your ExtraCare card number. TRUST MEMBER Catholic Charities USA February 24, 2021 CVS/Caremark April 1, 2021 In Caremark’s ongoing effort to assist our Plan in maximizing our health care investment while offering your plan members clinically appropriate prescription therapy, Caremark announced changes to the Standard Formulary effective April 1st, 2021. com or call 1-800-552-8159 to check coverage, copay and information about Choose your plan below to download your drug list. TTY/TDD users can call 711. been reviewed but not added to the Formulary or that have not yet been reviewed by the P&T Committee are considered Non-Formulary. 9% of members affected by formulary removals client savings expected in 2021 for those aligned to template formularies $4. 1, 2021 and is subject to change after this date. CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager for the 70/30 Plan, the 80/20 Plan and the High Deductible Health Plan. If you continue to fill prescriptions for them, you will have to pay the entire cost. Plus, you have access to up-to-date coverage information in your drug list, including – details about brands and generics, dosage/strength options, and information about prior authorization of your drug. (CVS pharmacies located in Target stores), CVS/caremark Mail Service, CVS/specialty Pharmacy Non-Medicare HBP Prescription Drug Benefit Administered Through CVS/caremark The Following Is a Summary Overview of the Prescription Drug Benefit for 2021 CVS is committed to “ensuring members have affordable access to clinically appropriate medications,” and they estimate fewer than 0. You can access and print the 2021 CVS Caremark Preferred Drug Guide (formulary) at www. com by clicking on “covered drug list” or by calling CVS Caremark at 1-800-240-9623. For crew enrolled in the High-Deductible Health Plan (HDHP), review CVS Caremark's Preventive Therapy Drug List, medications that help specific chronic conditions. Cign aMedicare. All other three-month mail order fills will be subject to the standard 3x copay. Food and Drug Administration (FDA) has approved more than 10,000 generic options for brand-name prescription drugs, so there is likely to be 2021 Check Drug Costs – Vermont Plans. VALUE FORMULARY The Kentucky Employees’ Health Plan utilizes CVS/Caremark’s 2021 Value Formulary. Formulary Lookup - Caremark Loading CVS Caremark Value Formulary Effective as of 04/01/2021. – 6 p. 2021 Formularies. We must approve the request before members can get the The Plan will cover the full cost of insulin beginning with the 2021 plan year. The Flexible Formulary drug lists will help you determine if your prescription is for a generic or a preferred drug. Massachusetts Commercial Formulary (02/19/2021) Tufts Health Plan Drug List in PDF : Downloading or printing the drug list is easy, just click on the options below. com – operational – October 1, 2017: 2021 Medicare Part D Browse a Plan Formulary (Drug List) - Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. There is a Performance Drug List Formulary for non-specialty medications and an Advanced Specialty Formulary for specialty medications. Medicare retirees will transition on January 1, 2022. CVS Caremark Mail Service Pharmacy Formulary Changes During a plan year, Cigna may make certain changes to our list of covered drugs. com. Please note: As under your current Nokia prescription drug coverage, prescription drug copayments will double EHP Prescription Drug Handbook EHP Prescription Drug Formulary EHP Maintenance Drug List Updates to EHP Drug Formulary Statin Medications for Primary Prevention of Cardiovascular Disease: As of January 1 st, 2018, under the provisions of the Affordable Care Act mandate regarding cardiovascular disease preventive health services, generic formulary low to moderate dose statins will be covered All maintenance medications must be filled in a 90-day supply at one of our Retail Maintenance Network pharmacies or through the CVS Caremark mail service program. INTRODUCTION . CVS Caremark is the pharmacy benefit manager (PBM) for the Plan’s prescription drug program. For information on the formulary or specific questions on covered drugs, please call CVS Caremark at 1-855-305-3028. Effective January 1, 2021, a $25 insulin copay cap will be in place for our members. For 2021, Express Scripts and CVS introduced step therapy for certain products and indications. com antes de usar la herramienta, la Effective April 1, 2021, Caremark will replace OptumRx as your PBM and will administer your prescription drug benefit on the Fund’s behalf. OptumRx will exclude an additional 38 drugs. ” Be sure to provide your CVS Caremark ID card to your pharmacist when you fill your first prescription in 2021. TTY users, please call 1-800-863-5488 toll-free. January 2021 - MI Medicaid Formulary Updates. Once activated, use your ExtraCare card at check out every time you shop at CVS Pharmacy. ALWAYS PRESENT YOUR CAREMARK PRESCRIPTION DRUG CARD TO THE PARTICIPATING RETAIL PHARMACY. An independent group of physicians, including multiple specialists and pharmacists, reviews all drugs on the Value Formulary to ensure complete clinical coverage in all therapeutic categories. 2021 Benefit Choices. For the most current list of covered medications or if you have questions: Call the number on your member ID card. January 2021 Kentucky Employees' Health Plan Value Formulary Quick Reference List The Kentucky Employees' Health Plan Value Formulary Quick Reference List is not an all-inclusive list but represents a summary of prescribed medications within select therapeutic categories. HR ADMINISTRATORS PORTAL. TTY users should call 711. When it refers to "plan" or "our plan," it means Humana Group Medicare Plan. On Jan. Overview: Massachusetts Commercial Tier 3 Formulary (03/12/2021) Welcome to the Tufts Health Plan Online Drug List: Here you can quickly and easily get information on drug coverage and tier placement of your medications. You can call our Customer Service Department at 1-800-868-5200 (TRS 711), Monday, Tuesday, Thursday, and Friday from 8 a. 2021 formulary (Elite) 1 : 2021 formulary (Exclusive) 1 : 2021 formulary (Value) 2021 formulary (Value Plus) Value Plus formulary. New formulary for 2021 • State, Local Education and Local Government Insurance Committees voted to move to a new formulary (approved list of medications covered by the plans) starting in January 2021 • Any member who is affected by this change will receive a letter from CVS Caremark in mid-November, as will his or her prescribing physician Cvs Caremark Medicare Formulary 2021 Health. This means these drugs will remain available at the same cost-sharing and with no new restrictions for those members taking them for the remainder of the coverage year. m. Preventive drugs have lower out-of-pocket costs than nonpreventive drugs. March 2021 - MI Medicaid Formulary Updates. November 2020 Formulary - 2021; Specialty Formulary - 2021; Return to Top. Member Handbook Your pharmacy benefits are covered through CVS Caremark. Discount Tier - Effective Jan 1, 2021. Decisions on formulary are made by a committ ee of independent, unaffiliated clinical pharmacists and physicians. com. Value Formulary . Call 1-855-240-0543 toll-free, 24 hours a day, seven days a week. CVS Caremark added five new companies to its Point Solution Management Service, which it launched last year to make it easier for businesses to implement digital health tools. Your prescription drug deductibles and copays will remain the same, except for specialty medications which will be part of a new program that reduces cost to both you and the Plan. mycpchembenefits. The PBM states that only 0. Cvs Caremark Medicare Formulary 2021 Health. You can access and print the 2021 CVS Caremark Preferred Drug Guide (formulary) at www. Effective April 1, 2021, Caremark will replace OptumRx as your PBM and will administer your prescription drug benefit on the Fund’s behalf. Generally, if you are taking a drug on our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 coverage year except as described above. 4 percent of members will experience any changes in 2021. The Plan’s Pharmacy Benefit Manager, CVS Caremark, is another valuable resource as you navigate through your decisions. ©2021 CVS Caremark. 13% off Offer Details: CVS Caremark. To locate an in-network Pharmacy and for a listing of CVS Caremark approved drugs (formulary), visit www. CVS Caremark Portal. should use the formulary to prescribe drugs for you. Advanced Control Specialty Formulary - Effective Jan 1, 2021. (CDPHP®) complies with applicable Federal civil rights laws and does not discriminate on January 2021 CareFirst Preferred Drug List - Formulary 2 The CareFirst Preferred Drug List is a guide to help you identify products that are both clinically appropriate and cost-effective. They list all the drugs covered by your plan. Medicare Pharmacy Help Desk This list has some formulary exclusions marked in Red. November 10, 2020 10:00 AM Eastern Standard Time DURHAM, N. Influenza. 2021 CVS Caremark Formulary. April 1, 2021 updates. Our contact information, 2021 Medicaid Formulary (List of Covered Drugs) Please Read: This document contains information about the drugs we cover in this plan. If you would like a comprehensive printable version of the drug list click the "Print Drug List" button on the left. should use the formulary to prescribe drugs for you. com is an easy way to make the most of your prescription benefits: 2021 CVS Caremark Formulary Updates Changes to CVS Caremark template formularies effective January 1, 2021 continue our legacy of innovation as well as delivering value and quality care — helping clients save money 2021 Formulary (List of Covered Drugs) Find a Pharmacy Generations Advantage Prime (HMO POS), Select (LPPO), Focus DC (HMO SNP), Value Plus (HMO) and Flex (RPPO) plans have Part D Prescription Drug coverage built right into the plan. 13% off Offer Details: CVS Caremark. NEW – In January 2021, the covered drug list (formulary) changed. com or contact a CVS Caremark Customer Care representative at 1-800-933-NALC (6252). The CVS/Caremark prior authorization form is to be used by a medical office when requesting coverage for a CVS/Caremark plan member’s prescription. 1% of members will not experience any changes from formulary removals effective January 1, 2021 per member expected in 2021 for clients aligned to our template formularies $130 savings It may also require you get a new prescription or take action before certain medications are covered. The State Health Plan utilizes a custom, closed formulary (drug list). With the CVS Caremark Maintenance Choice ® Program, you can have a 90-day supply of your medication filled directly at a The HMSA drug formulary is a list of prescription drugs, both generic and brand name, that are covered under your drug plan. 2021 CVS/Caremark Prescription Drug Formulary Changes Effective January 1, 2021 Formulary Exclusions: Below is a list of medicines that will no longer be covered as of January 1, 2021. You must contact CVS Caremark or visit www. Please refer to the table below for bank identification number (BIN) and processor control number (PCN) information. April 2021 Advanced Control Specialty Formulary® The CVS Caremark® Advanced Control Specialty Formulary® is a guide within select therapeutic categories for clients, plan members and health care providers. Have your CVS Caremark member ID number ready; – By phone: Call CVS Caremark at 1-800-240-9623 for automated refill service. 2021 MVP Commercial/Child Health Plus Formulary (PDF) —Applies to large groups; plans offered by employers with greater than 100 employees, MVP Child Health Plus, and Administrative Services Only plans. ” How to choose your formulary. m. 2021 MVP Marketplace Formulary (PDF) — Applies to individuals who purchase their health plan on their own from NY State of Health, The Official Health Plan Marketplace—including the Essential Plan—or Vermont Health Connect or who purchase the plan directly from MVP. 4 billion 99. com or contact a CVS Caremark Customer Care representative. Commercial Large Group Formulary; Caremark. All other drugs that are on the formulary are grouped into tiers (as shown below). Massachusetts Commercial Formulary (02/19/2021) Tufts Health Plan Drug List in PDF : Downloading or printing the drug list is easy, just click on the options below. Generics should be considered the first line of prescribing. 4 MB) Caremark High Option $5 / $10 Prescription Plan (available to unrepresented, FOP and retirees) Advance Control Formulary ( April 2021) Mobile App Information From 2017 to 2020, CVS Caremark increased the numbers of excluded drugs by 88%, and Express Scripts by a whopping 208%. m. The member’s plan determines which formulary applies: Advantage MD PPO/Plus PPO/Premier PPO Formulary Advantage MD HMO Formulary. January 2021 SilverScript ® Insurance Company Employer Group Waiver Plan (EGWP) Formulary Drug Removals Below is a list of medicines by drug class that have been removed from SilverScript EGWP Medicare Part D How to choose a formulary If you are a prospect shopping for a commercial plan , please call Customer Service for help in determining which formulary to choose. What is not changing? You will also be able to continue to use the current network of Participating Pharmacies. If you have questions about the request process or the status of a request, contact CVS/caremark, HMSA’s pharmacy benefits manager. • Fewer than 0. 2021 Plans. 1 Not for distribution beyond intended recipient. 2021 Standard Control Formulary Updates 2021 Standard Control Formulary Removals and Updates Standard Control Formulary Removals. To view the exact drug formulary, simply click on the below link: 2021 PIEDMONT INDIVIDUAL MARKETPLACE RX DRUG FORMULARY Effective 03/01/2021 What is a formulary? A formulary is a list of prescribed medications or other pharmacy care products, services or supplies chosen for their safety, cost, and effectiveness. Effective January 1, 2021, Blue Shield of California pharmacy claims will be processed by CVS Health (CVSH). You can call our Customer Service Department at 1-800-868-5200 (TRS 711), Monday, Tuesday, Thursday, and Friday from 8 a. 2021. The CareFirst Preferred Drug List represents a summary of Formulary 3 and is a guide to help you identify drugs that are both clinically appropriate and cost-effective. com or contact a CVS Caremark Customer Care representative at 1-888-321-3261. At the start of 2020, the two companies removed more than 300 medications from their formularies, and they’re dropping nearly 200 medications from their formularies for 2021. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on Starting January 1, 2021: Submit your mail service refill request for a transferred maintenance prescription: – Online: Register at Caremark. Have Important 2021 Pharmacy Formulary Changes. 2021 Formulary (PDF) Fidelis Medicare Advantage and Dual Advantage Plans 2021 Starting Jan. com antes de usar la herramienta, la información de diseño de su plan también se utilizará para estimar de 2021 Formulary Changes Effective 1/1/2021 Effective April 1, 2021, Caremark will replace OptumRx as your PBM and will administer your prescription drug benefit on the Fund’s behalf. Exactus Specialty Pharmacy Available at no additional cost to patients undergoing treatment for long-term, life-threatening or rare conditions. This document can assist practitioners in selecting clinically appropriate and cost-effective products for their patients. Search the 2021 Medicare Formulary I drug list. CVS Caremark has a broad pharmacy network. The Blue Cross of Idaho formulary has multiple tiers, with the first tier costing you the least and the fourth tier costing you the most. on our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 coverage year except as described above. S. This formulary is effective on March 1, 2021. In addition, you will need to contact CVS Caremark to schedule your first mail order delivery and to enroll in CVS Caremark’s automatic refill program. This formulary is effective on January 1, 2021. to 6 p. Opportunity to a part d drug is available at the peia plans and respiratory conditions and expedited requests by another organization or medically unnecessary care will get the year. Employees of the To compare formulary lists (preferred drug lists), cost-savings programs and to obtain a list of pharmacies that participate in the various health plan networks, plan participants should visit the website of each health plan. This useful reference tool can assist medical providers in selecting CVS Caremark excluded 57 drugs from its standard formulary in 2021 compared to 100 drugs in 2020. A physician will need to fill in the form with the patient’s medical information and submit it to CVS/Caremark for assessment. Formulary Search our formulary for covered drugs and get the information you need. Certain health plans notify plan participants by mail when a prescribed medication they are currently taking is benefit management to CVS Caremark. Retail Maintenance Network (RMN) of pharmacies that can fill the 90 day mandatory maintenance drugs In West Virginia is listed here in PDF To view it in excel format, click here. For specific information, visit Caremark. The formulary is a master list of prescription drugs that have CVS Caremark is committed to helping you get the most effective medications at the best price and keeping access to prescription medications affordable. Formulary Changes. caremark. These tools include information based on the formulary and are subject to change in 2021. This is a closed formulary and only those drugs listed in this formulary will be covered by MedStar Family Choice. Formulary changes will be reflected in the updated formularies and in the formulary changes lists below. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for their patients. The formulary or drug list is regularly updated throughout the year, on a quarterly basis. April 2021 State of Tennessee Drug List with Advanced Control Specialty Formulary® The CVS Caremark® Performance Drug List with Advanced Control Specialty Formulary® is a guide within select therapeutic Effective April 1, 2021, Caremark will replace OptumRx as your PBM and will administer your prescription drug benefit on the Fund’s behalf. The formulary is subject to change and all previous versions of the formulary are no Caremark. 2021 Drug Formulary (PDF) 2021 Formulary Quick Reference Guide (PDF) Qualified Health Plans (Metal-Level Products) 2021 Formulary (PDF) Essential Plan. 13% off Offer Details: CVS Caremark. Prescription drug coverage (Medicare Part D) is administered by SilverScript (affiliated with CVS Caremark): $110 ($60 Non-formulary brand for asthma, diabetes & hypertension) Specialty Drugs: Require Prior Approval and we utilize the NALC's Advanced Control Specialty Formulary (Available only through Caremark Specialty Pharmacy Mail Order) You Pay: Mail Order: up to 30 day supply: $200: Mail Order: 31 - 60 day supply: $300: Mail Order: 61 - 90 day Formulary changes for 1st QTR 2021 (PDF, 110 KB) Prescription drug prior authorization form This form is for participating physicians and pharmacies to obtain medications that are not on the Formulary or require prior authorization. C. Medicare-eligible Montgomery County Government retirees and their Medicare-eligible dependents who have coverage through either the Indemnity medical plan or one of the County’s Caremark prescription plans (High or Standard Option) will have their prescription drug coverage provided by Caremark’s Medicare Part D Search our Pharmacy Clinical Policy Bulletins for the following commercial formulary plans: Premier, Premier Plus, Value Plus, Small Group ACA, Advanced Control Plans-Aetna, and Standard Opt Out Plans-Aetna. com or contact a CVS Caremark Customer Care representative. 13% off Offer Details: Change to the brand-name medication: The generic medications in the letter you received will no longer be covered by the formulary with CVS Caremark after April 1, 2021. 4 billion in 2021. A formulary is a list of prescription drugs and therapies that an insurer has approved for its members. CVS Caremark Health Brand Exclusive Products A panel of experts at CVS Caremark works throughout the year to develop the formulary . You can access and print the 2021 CVS Caremark Preferred Drug Guide (formulary) at www. 1-800-852-7826 (TTY: 1-800-662-1220) If approved, CVS/caremark can provide an override to the formulary which will allow your drug to be covered under the plan even though it’s not on the formulary. Your 2021 Select Standard Formulary Effective January 1, 2021. For an updated formulary, please contact us. The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. This means that regardless of formulary tier placement, any covered insulin or insulin approved through the formulary exceptions (medical necessity) process will have a $0 copay/coinsurance for members. For information on the formulary or specific questions on covered drugs, please call CVS Caremark at 1-855-305-3028. For more recent information or other questions, please contact the MVP Medicaid Customer Care Center. This means these drugs will remain available at the same cost-sharing and with no new restrictions for those members taking them for the remainder of the Select a formulary list below. Food and Drug Administration (FDA) has approved more than 10,000 generic options for brand-name prescription drugs, so there is likely to be We are pleased to provide the 2021 . HDHP Preventive Therapy Drug List. ” Rx Drug Formulary. It includes both brand and generic prescription medications. 2021 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Once released, you’ll find the updated formulary for 2021 in the SilverScripts document library. This means these drugs will remain available at the same cost sharing and with no new restrictions for those members taking them for the remainder of the coverage year. ADDITIONS: See the full list of generic and name brand drugs covered by MVP Health Care plans that offer prescription drug coverage. If you are currently taking a medication on the above formulary exclusion list, you should speak with your doctor about changing CVS Caremark is committed to helping you get the most effective medications at the best price and keeping access to prescription medications affordable. Formulary Drug Removals – 2021. The new formulary preferred drug list is enclosed. Brand-Name Drugs CVS Caremark takes a similar approach to the category, because it lists preferred and excluded options by condition. We update these documents each year. The Advantage MD formularies are subject to change at any time upon Medicare approval. 2021 Advanced Control Specialty Preferred Drug List. April 2021 North Carolina State Health Plan Preferred Drug List - Traditional Pharmacy Benefit The North Carolina State Health Plan Preferred Drug List - Traditional Pharmacy Benefit is a guide within select therapeutic Your 2021 Formulary SignatureValue 3-Tier This formulary is accurate as of Jan. SilverScript Formulary 2021 Any time you want coverage for your medications, it’s important to check on the drug coverage plan that each specific company offers. com or contact a CVS Caremark Customer Care representative at 1-877-522-TNRX (8679). At CVS Caremark, Stelara and Xeljanz are preferred only after patients step through Humira. The Multi-Tier Formulary In most cases you will be responsible for a portion of the cost of each prescription you have filled, and depending on the drug prescribed, your cost can vary. Kaiser Permanente . CVS Health Corp. We are pleased to provide the 2021 Molina Healthcare of Washington Apple Health (Medicaid) Preferred Drug List (Formulary) as a useful reference and informational tool. These drugs are selected for their quality, effectiveness and cost based on current medical research and input from a committee of doctors and 2021 Drug Formulary (PDF) 2021 Formulary Quick Reference Guide (PDF) HealthierLife (HARP) and Medicaid Managed Care. Why could my medication cost change? CVS Caremark will continue to look for ways to help make getting your medications more affordable. The drugs represented have been reviewed by a National Pharmacy and Therapeutics (P&T) Committee and are approved for inclusion. m. For assistance with processing Blue Shield claims, please refer to the Pharmacy Help Desk telephone numbers. m. 1, 2021, Travelers plans will be moving to the CVS Caremark formularies for both traditional and specialty medications. 1, 2021, patients with inflammatory conditions who are part of the Express Scripts formulary will be forced to switch from the IL-17 inhibitor secukinumab to ixekizumab — whether they Clients aligned to our template formularies are expected to save $4. Caremark. 2021 opioid updates. 2 Drug Class Removed Product(s) Formulary Options this document. Advantage formulary update. New Prescription Drug Administrator: CVS Caremark CVS Caremark will replace Express Scripts as the prescription drug administrator for participants enrolled in the UnitedHealthcare Group Medicare Advantage (PPO), Point of Service (POS) and Traditional Indemnity options, effective January 1, 2021. com or contact a CVS Caremark Customer Care representative. caremark. 9 percent of members will experience any changes from the formulary removals. Generally, clients aligned to our Standard Control Formulary (SCF) have realized much greater savings than clients who have opted for a broad formulary with no drug exclusions, and it covers all generics and most brand drugs. caremark. You can access and print the 2021 CVS Caremark Preferred Drug Guide (formulary) at www. 13% off Offer Details: necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non-formulary prescription request criteria. Formulary Drug Removals – 2020. com under “Health & Wellness,” then “Health. A copy of the Performance Drug List can be found here. Retail Pharmacy Program - CVS Caremark When this drug list (formulary) refers to "we," "us", or "our," it means Humana. You will pay a maximum of $35 for a 1-month supply of insulin during the deductible, initial coverage, and coverage gap or “donut hole” stages of your benefit. Customer Service Pre-Enrollment: 1-833-244-3887. Beginning March 22, 2021, to learn if your medication is covered, you can call CVS Caremark at 1-855-311-3162. In some cases, if there are other drugs that offer the same or similar clinical benefits at a lower cost, the plan will no longer cover certain drugs and other products on the current drug list. Call your doctor and ask them to send a new 90-day prescription to CVS Caremark Mail Service Pharmacy. Advanced Control Specialty Drug Removals. What is not changing? You will also be able to continue to use the current network of Participating Pharmacies. January 1, 2021 updates. There are three documents in the Formulary column. Capital District Physicians' Health Plan, Inc. 2021 Standard Control Formulary. If you continue to fill prescriptions for them, you will have to pay the entire cost. and Wednesday from 10 a. A comprehensive formulary is a complete list of covered drugs. For information on the formulary or specific questions on covered drugs, please call CVS Caremark at 1-855-305-3028. m. Injectable and Infused Drugs Covered under the Pharmacy Benefit – Effective January 1, 2021. Additionally, if a medication is available as a generic formulation, this will be Anthem's preferred agent, unless otherwise noted. should use the formulary to prescribe drugs for you. Drugs with Quantity Limits and Prior Authorization Requirements. If you continue to fill prescriptions for them, you will have to pay the entire cost. mycpchembenefits. com to order refills and check the status of your order at any time. January 2021 NALC Health Benefit Plan Formulary Drug List with Advanced Control Specialty Formulary® The NALC Health Benefit Plan Formulary Drug List with Advanced Control Specialty Formulary® is a guide within select therapeutic The 2020 Advanced Control Formulary (effective 10/01/2020) and the 2021 Advanced Control Formulary (effective 01/01/2021) are lists of medications selected for coverage under the pharmacy benefit, based on efficacy, safety, cost-effectiveness, and clinical evidence. If you are a prospect shopping for a commercial plan, please call Customer Service for help in determining which formulary to choose. necessity or formulary exception requests will be reviewed based on drug-specific prior authorization criteria or standard non-formulary prescription request criteria. Members should note that this does NOT mean members have to go to a CVS pharmacy location for their prescriptions. January 2021 Updated 11/01/2020 Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary® The CVS Caremark® Performance Drug List - Standard Control for Clients with Advanced Control Specialty Formulary® is a guide within select therapeutic categories for clients, plan members and health care providers. Meanwhile, UnitedHealth Group’s OptumRx subsidiary will exclude 19 medications and products while adding back five and implementing restrictions on others, AIS Health reported. Plan Year 2021 CVS Caremark Maintenance Choice® Program Even though you can continue to fill 3 0-day supplies at the pharmacy of your choice, you can save time and money by using the CVS Caremark Maintenance Choice ® Program. Your formulary can change throughout the year, so it’s smart to log on to caremark. What is not changing? You will also be able to continue to use the current network of Participating Pharmacies. April 2021 Advanced Control Formulary™ The Advanced Control Formulary™ is a guide within select therapeutic categories for clients, plan members and health care providers. The formulary, or drug list, is the main source. Download/Print by Therapeutic Class . Optimize formulary standing of your drug. If you have any questions about coverage of a certain product, please contact us at 1-844-410-0746. 2. Consider the ulcerative colitis indication. PBMs use formulary exclusions as leverage in their negotiations with drug Formulary Preferred Drugs Will there be changes to Travelers formulary list of preferred drugs? Yes. Visit your plan’s website on your member ID card to: • Find a participating retail pharmacy by ZIP code. For more recent information or other questions, please contact the MVP Customer Care Center. caremark 2021 formulary Express Scripts (ESI), CVS Caremark, and OptumRx have published their formulary exclusion lists for 2021. to 6 p. . 4 percent of members will experience any changes in 2021. This means these drugs will remain available at the same cost sharing and with no new restrictions for those members taking them for the remainder of the coverage year. Download 2021 Formulary If you would like a formulary mailed to you, you can request one by calling Member Services at 1-800-240-3851 (TTY 711). To get updated information about covered drugs, please contact OptumRx. Caremark. Benefits at a Glance. caremark 2021 formulary Formulary A formulary is a list of prescription medications developed by a committee of practicing physicians and practicing pharmacists who represent a variety of specialty areas and who are knowledgeable in the diagnosis and treatment of disease. Value Formulary has clinical requirements for certain plan medications. pdf Author: C020179 Created Date: 10/13/2020 12:09:36 PM drug on our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 coverage year except as described above. Generics should be considered the first line of prescribing. $15 Tier 1 (generics) $40 Tier 2 (formulary brands and some generics In 2021, CVS removed 57 drugs from their Standard formulary, adding 7 back across multiple therapeutic areas: anticonvulsants, diabetes, growth hormone, ophthalmic, and osteoarthritis classes. document. This formulary was updated on January 1, 2021. should use the formulary to prescribe drugs for you. com or call 1-800-824-6349. You can search or print your drug list from the options below. com for the most up-to-date Formulary listing. Download/Print by Tier. Existing members who are impacted by this change have been notified by mail. CVS Caremark confidential and proprietary information. Once you receive your new CVS Caremark ID card in December, register on Caremark. m. Compare drug coverage and check co-pays or co-insurance under the health plans available to you. CVS also excluded drugs from new categories such as acromegaly, oncology, gastrointestinal, ophthalmic, Parkinson’s disease, cardiovascular and so on. 2021 opioid updates Rhode Island Commercial Tier 3 Formulary (03/26/2021) Tufts Health Plan Drug List: Formulary A formulary is a list of prescription medications developed by a committee of practicing physicians and practicing pharmacists who represent a variety of specialty areas and who are knowledgeable in the diagnosis and treatment of disease. our 2021 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 2021 coverage year except as described above. local time, or visit . Download/Print in Alphabetic Order Caremark. of medicines preferred for coverage by your benefits plan. 's Caremark will exclude 57 medications from its 2021 formulary and add six back. Notice of Formulary Updates MediGold may add or remove drugs from our formulary during the year. 2021 MVP Health Care ® Commercial Formulary (List of Covered Drugs) Please Read: This document contains information about the drugs we cover in this plan. 1. This new program will apply a copay of no more than $25 per 30-day supply of preferred insulins on our formulary OR a medically necessary alternative (whether on the formulary or not). current as of January 1, 2021. Additionally, if a medication is available as a generic formulation, this will be Anthem's preferred agent, unless otherwise noted. United Healthcare’s 2021 formulary updates include 27 new exclusions, while four medications not previously covered under most United Healthcare plans are now eligible for coverage. You’ll want to be aware of covered medications when you begin shopping for drug plans. 2021 National Preferred Formulary Exclusions ANTIINFECTIVES Antibiotic Agents - Vancomycins (Oral) FIRVANQ vancomycin capsules, vancomycin oral solution Antifungal Agents (Oral) TOLSURA itraconazole Antivirals (Oral) SITAVIG acyclovir oral or cream, famciclovir, valacyclovir Chagas Disease Agents LAMPIT BENZNIDAZOLE AUTONOMIC & CENTRAL NERVOUS SYSTEM drug on our 2021 formulary that wascovered at the beginning of theyear, we will not discontinue or reducecoverage of the drug during the 2021 coverage yearexcept as described above. A formulary represents the prescription therapies believed to be a necessary part of a quality treatment program. Medications are listed by categories or classes and are placed into cost levels known as tiers. Michigan Formulary Quarterly Summary-Last updated 7/25/2019 . Still, only a handful of products excluded by either PBM are likely to impact many members adversely, says Marc Guieb OTC - Over the counter PA - Prior Authorization PA** - PA Applies if Step is Not Met QL - Quantity Limits ST - Step Therapy 1 EXCH_CVSC 5T STND eff 01/01/2021 Drug Name Drug Tier Requirements/Limits caremark medicare d formulary is displayed dynamically on our formulary payors are integral to. This formulary was updated on 04/01/21. AcariaHealth Medicaid/CHIP Pharmacy Help Desk Toll Free: 1-866-768-0468 Prior Auth Requests Phone: 1-866-399-0928 Fax: 1-866-399-0929. Prior Authorizations. Your estimated coverage and copayment/coinsurance may 2021 Fidelity Formulary and Drug Cost for Annual Enrollment. Download/Print by Tier. com under “Health & Wellness,” then “Health. ” Be sure to provide your CVS Caremark ID card to your pharmacist when you fill your first prescription in 2021. Generics should be considered the first line of prescribing. Because the new CVS Caremark formulary is not exactly the same as the previous formulary with Express Scripts, you’ll need to make some changes before April 1, 2021. 1, 2021: Over-The-Counter and Durable Medical Equipment List. Non-covered medications The Plan has a custom closed formulary. The formulary is subject to change and all If you create an account with Caremark. Q: Does this change include We are pleased to announce that starting January 1, 2021, CVS Caremark replaced Express Scripts as the Plan’s pharmacy benefit manager. Generally, the lower the tier, the less you pay. Why are generic medications so widely used? The U. HMO 2021 CVS Caremark Formulary Updates Changes to CVS Caremark template formularies effective January 1, 2021 continue our legacy of innovation as well as delivering value and quality care — helping clients save money Therapeutic Search Formulary last updated: 11/27/2020 Searching Enter the first few letters of the drug you wish to add then select the drug from the drop-down menu. ” CVS Caremark – Formulary Exclusions – January 1, 2021: Click Here to download a printable PDF- CVS Caremark Formulary Exclusions effective 1/1/2021. CVS Caremark added 62 new exclusions. The requirements include: Prior Authorization (PA): This means that your doctor has to contact CVS Caremark and confirm that a specific medication meets plan guidelines for covering your condition SilverScript Formulary for 2021. We will generally cover anything listed in our formulary as long as the drug is medically necessary, the prescription is filled at a MetroPlus network pharmacy, and other plan rules are followed. ACA Covered under the Affordable Healthcare Act-no member cost share NF Non-Formulary PA Prior authorization required PD Preventive Drug Effective Jan. Fidelity Health Plan – Individual (Pre-Deductible) Fidelity Health Plan – If You Cover Family Members* (Pre-Deductible) Fidelity Health Plan – Individual (Post-Deductible) Fidelity Health Plan – If You Cover Family Members* (Post-Deductible) HealthFlex PPO. Meanwhile, UnitedHealth Group’s OptumRx subsidiary will exclude 19 medications and products while adding back five and implementing restrictions on others, AIS Health reported. Treatments marked in red with an asterisk (*) require trial and failure of preferred, covered options or approval via prior authorization to be covered. m. Generics should be considered the first line of prescribing. com Phone: 1-866-249-6167 . One of the best ways to get this information is using the formulary, which is the main list of the drugs that are in any coverage. CVS Caremark Value Formulary Effective as of 04/01/2021. – 8 p. as a useful reference and informational tool. Here you will find pharmacy-related information including the Medicare formulary as well as links to request or appeal drug coverage. The Piedmont Community HealthCare prescription drug benefits are administered by CVS/Caremark, one of the largest pharmacy benefit managers in the country. current as of January 1, 2021. Visit your plan’s website on your member ID card to: • Find a participating retail pharmacy by ZIP code. CVS Caremark provides several resources to support members, including: • A convenient and easy to use Mobile App Medications not listed on the formulary are considered to be non-formulary and are subject to prior authorization. Learn more about how to read a drug list. NonCovered Injectables - Effective Jan 1, 2021. They provide you with an up-to-date drug formulary every year. (CDPHP) is pleased to provide the CDPHP Medicaid Select/HARP Clinical Formulary 2021 as a useful reference and informational tool to assist practitioners in selecting clinically appropriate and cost-effective drug therapies. com under “Health & Wellness,” then “Health. For specific information, visit Caremark. current as of January 1, 2021. 2021 Prescription Drug List This is the list of covered medications effective January 1, 2021 for 3-tier, 4-tier, and 6-tier plans Sparrow Employee Prescription Drug List If you are a Sparrow Caregiver (employee) and are in group L0001269, then this prescription drug list is applicable to you Explore DRG's Fingertip Formulary. Please note that if you have a HealthPartners MSHO plan, the search tool gives results for Medicare Part D covered drugs only. caremark formulary 2021

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