You can search the formulary alphabetically by selecting the first letter of the brand or generic name of the drug you are looking for. You can also search by entering the first few letters of the name of the drug.
If you don’t know the name of the drug, you can search by what medical issue the drug treats. This is known as the Therapeutic Class.
Some of the medications on the list require prior approval. These medicines are marked with a symbol in the Notes & Restrictions column. If the drug needs prior authorization, your doctor can submit a form or a request at CoverMyMeds.com
Other drugs may have limits. Some drugs will need to be given by a special pharmacy or require step therapy. These medicines are marked with a symbol in the Notes & Restrictions column.
If your drug is not included in this formulary, you should first contact Member Services and ask if your drug is covered.
Your doctor may request a medication that is not on the list only if it’s a medical necessity. If the formulary drugs have failed, your doctor should document these on the Medicaid Drug Exception Form picture_as_pdf
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This information is issued on behalf of Highmark Wholecare, which is an independent licensee of the Blue Cross Blue Shield Association. Highmark Wholecare serves a Medicaid plan to Blue Shield members in 13 counties in central Pennsylvania, as well as, to Blue Cross Blue Shield members in 14 counties in western Pennsylvania. Highmark Wholecare serves Medicare Dual Special Needs plans (D-SNP) to Blue Shield members in 14 counties in northeastern Pennsylvania, 12 counties in central Pennsylvania, 5 counties in southeastern Pennsylvania, and to Blue Cross Blue Shield members in 27 counties in western Pennsylvania.