Prescription Drug List 2004

The contents of the Prescription Drug List represent outpatient prescription drugs that may be covered for Members under Oxford Health Plans’ Drug Formulary. In certain circumstances, Members may have a Three-Tier prescription drug benefit, which includes a
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co-payment tier for “Preferred Brand Drugs.” Prescription drugs appearing in bold represent drugs that are on Oxford’s Preferred Drug List. We encourage Members, where medically appropriate as determined by the prescribing physician, to use the drugs on this list to help reduce their out-of-pocket expenses.