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How to Use the Online Formulary

A formulary is an industry word that means a list of prescription drugs.

Our online formulary lets you search for medications with these easy to follow steps:

1. Begin your search by entering a drug name in the “Check the formulary” box and selecting "search" (a minimum entry of the first four letters of the drug name is required).
2. You will be required to select your state of residence in order for the tool to provide you with the most accurate information.
3. Click on the selection that shows the strength and form of the drug you want to look up.
4. Pricing results will be displayed
5. You can search for another drug by selecting the “Start over to get pricing for another medication” link beneath the chart.

Formulary Change Notice
Click here for information
Exceptions, Appeals and Grievances
Click here for information
2009 Searchable Formularies

AdvantraRx Value

AdvantraRx Premier

AdvantraRx Premier Plus

Printable 2009 Formularies
AdvantraRx Comprehensive Formulary (PDF)
Prescription Drug Forms

Physician Medicare Part D Coverage Determination Request Form

Physician Prior Authorization Forms

Physician Quantity Limit Exception Request Form

Prescription Drug Paper Claim Form

Instructions for completing the Medicare Prescription Drug Coverage Determination Form

Member Request for Medicare Prescription Drug Coverage Determination

Member Request for Medicare Prescription Drug Coverage Redetermination

Formulary FAQ's

What is a Formulary?

A formulary is a list of drugs selected by AdvantraRx in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.  AdvantraRx will generally cover the drugs listed on our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed.

Both brand-name drugs and generic drugs are included on our formulary.  A generic drug has the same active-ingredient formula as the brand-name drug.  Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and as effective as brand-name drugs.

What Are Drug Tiers?

Drugs on our formulary are organized into different drug tiers, or groups of different drug types.  The amount you pay for each prescription depends on which drug tier your medication is in.  The higher the tier the higher the cost-sharing will be.

Can The Formulary Change?

We may add or remove drugs from our formulary during the year.  Changes in the formulary may affect which drugs are covered and how much you will pay when filling your prescription.  We will send written notice of changes to our formulary to all AdvantraRx members who are using a particular drug.  This notice will be sent at least 60 days before the change will take effect.

However, if a drug is removed from our formulary because the drug has been recalled from the market, a notice will not be given.  Instead, we will remove the drug from our formulary immediately and notify members about the change as soon as possible.

How Can I Request An Exception To The Formulary?

You can ask us to make an exception to our coverage rules.  Generally, AdvantraRx will only approve your request for an exception if the alternative drugs included on the plan's formulary or the low-tiered drug would not be as effective in treating your condition and/or would cause you to have adverse medical effects.

Your prescriber must contact our clinical prior authorization department to request an exception.

What is Utilization Management?

For certain prescription drugs, AdvantraRx has additional requirements for coverage or limits on our coverage.  These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs.  A team of doctors and pharmacists developed these requirements and limits for AdvantraRx to help us to provide quality care to our members.  Examples of utilization management tools are described below:

  • Prior Authorization: AdvantraRx requires you to get prior authorization for certain drugs.  This means that you will need to get approval from AdvantraRx before you fill your prescription.  If you don't get approval, AdvantraRx may not cover the drug.
  • Quantity Limits: For certain drugs, AdvantraRx limits the amount of the drug that we will cover per prescription or for a defined period of time.
  • Step Therapy: In some cases, AdvantraRx requires you to first try one drug to treat your medical condition before we will cover another drug for that condition.  For example, if Drug A and Drug B both treat your medical condition, AdvantraRx may require your doctor to prescribe Drug A first.  If Drug A does not work for you, AdvantraRx will then cover Drug B.

You can find out if your drug is subject to these additional requirements by looking in the AdvantraRx formulary.  If your drug does have these additional restrictions or limits, you can ask AdvantraRx to make an exception to our coverage rules.  See the section above, "How Can I Request An Exception To The Formulary?"

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Y0022_PDPCCP_2013_4006_1202b Approved
CMS Approved Date: 02/08/2013
Page Last Updated: 12/14/2015

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