Prescription Drug List
The Prescription Drug List (PDL) outlines covered medications and organizes them into cost levels, also known as tiers. It includes both brand-name and generic prescription medications approved by the Food and Drug Administration (FDA).
The PDL may not be a complete list of medications, and not all medications listed may be covered under every plan. Please review your client’s benefit plan documents to see which medications are covered under their plan. For specific information about a member's benefits, the member should refer to their Certificate of Coverage and/or Summary of Benefits.
If you have any questions about a PDL, please call Client Services at 1-888-201-4216.
PDLs are accurate at the time they are released and are subject to change after that date.
January 1, 2018 PDLs
Access Three-Tier (New York and New Jersey)
Access Three-Tier Updates Summary Flier
Advantage Four-Tier (Connecticut)
Advantage Three-Tier (Connecticut)
Advantage Three-Tier (New York and New Jersey)
Advantage Three-Tier Updates Summary Flier
Enhanced Three-Tier (New York and New Jersey)
Enhanced Three-Tier Updates Summary Flier
Traditional Three-Tier (Connecticut)