The document is … Inclusion on the list does not guarantee coverage. The UPHP Medicaid-CSHCS-Healthy Michigan formularies are aligned with the MDHHS (Michigan Department of Health and Human Services) Common Formulary for all contracted health plans in the State of Michigan per the Comprehensive Health Plan contract. An Introduction to Independent Health’s 2020 MediSource and Child Health Plus Formulary The following information applies to Independent Health’s New York State Sponsored Plans, Child Health Plus and MediSource (Medicaid). For more recent information or other questions, please contact Viva Medicare at 1-800-633-1542 or, for TTY users, 711, Monday – Friday, from 8 a.m. – 8 p.m. (from Oct. 1 – March 31: seven days a week, 8 a.m. – 8 p.m.) or … The Total Health Care (THC) Medicaid Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals and members in the selection of cost-effective drug therapy. Approved Formulary File ID: 00020122 Effective January 2020 For more recent information or other questions, contact us at . 2020 Comprehensive Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN . FORMULARY PRODUCT ALTERNATIVE LIST October 2020 QL = Quantity Limitations ST= Step Therapy *Indicates Medication Is Covered Generically NON‐ FORMULARY DRUG COVERED ALTERNATIVE(S) ACIPHEX Prilosec20mg* &40mg,Protonix20mg*&40mg ACCOLATE Singulair* ACTONEL Fosamax*(QL), Evista* ADMELOG Apidra, Novolog, Humalog 2020 MEDICAID DRUG FORMULARY Effective October 1st, 2020 PLEASE READ: THIS DOCUMENT HAS INFORMATION ABOUT THE PRESCRIPTION DRUGS WE COVER. PDL_January_1_2020.pdf. For more recent information or other questions, please contact Community Health Choice Member Services, at 1 … For more recent information or other questions, please contact us, Bright Health, at 1-833 … Effective December 2020 . Texas Medicaid CHIP Formulary. The plan will cover drugs on this list. For more recent information or other questions, please contact Dean Health Plan, Inc. at 1-877-232-7566 (TTY: 711), 8 am – 8 pm, weekdays (year-round) and weekends (Oct. 1 – Mar. 2020. Please select a drug from the list below to see all coverage details regarding the medication. Please refer to your “Member Handbook or other plan materials” to determine if your drug is covered. 1-800-852-7826 (TTY: 1-800-662-1220) Monday-Friday, 8 am - 6 pm Eastern Time Visit … 2020 Medicare Part D Formulary (List of Covered Drugs) Please Read: This document contains information about the drugs we cover in this plan. For more recent information or other questions, please contact Allwell Dual Medicare (HMO D-SNP) at: State Phone … Members must use participating … For more recent information or other questions, please contact Optimum HealthCare, Inc. If the rules for that drug are met, the plan will cover the drug. For an updated formulary, please contact us. This formulary was updated on 12/01/2020. Drugs must also be filled at a plan network pharmacy. 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. The drugs on the list are selected by PrimeWest Health with the help of a team of doctors and pharmacists. Medicaid List of Covered Drugs (Formulary) 2020 Blue Plus . i EMBLEMHEALTH ESSENTIAL PLAN FORMULARY This guide tells you about our drug plan and has our formulary – the list of drugs we cover. Some drugs may have coverage rules. Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Can the Plan’s Drug List change? 2020 FORMULARY PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN This formulary was updated on 12/01/2020. 2020 Medicaid Formulary (List of Covered Drugs) Please Read: This document contains information about the drugs we cover in this plan. 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