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2012 Formulary Documents

Current Formulary Documents

o        2012 Tiered Commercial Formulary

o        2012 Alphabetical Formulary Listing

o        2012 Rx Standard Step Therapy List

o        2012 Quantity Limit List

o        2012 Formulary Changes

Medco Forms

o        Medco Mail Order Form

o        Medco Mail Order Form – Spanish version

o        Health Allergy and Medications Questionnaire

o        Health Allergy and Medications Questionnaire – Spanish version

o        Direct Claim Form

o        Direct Claim Form – Spanish version

Dual Eligible Forms

o        Dual Eligible Medco Mail Order Form

o        Dual Eligible Direct Claim Form

2011 Formulary Documents

o        2011 4-Tier Commercial Formulary

o        2011 2-Tier Commercial Formulary

o         Medicare Part D formularies (2-tier, 4-tier).

Current Prior Authorization Forms

Click here to print or download Pharmacy Prior Authorization forms.

Other Forms

o        LDI Mail Order Form

o        Walgreen’s Mail Order Form

o        Caremark Direct Claim Form

HIPAA

Transaction and Code Sets and other valuable HIPAA (Health Insurance Portability & Accountability Act) information.