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Member Formulary

Is your medicine covered?

 

A formulary is a list of covered drugs for your health plan. The drugs on this list are selected by the plan with the help of a team of doctors and pharmacists. The drugs on this list tell you if there are any rules you need to follow to get your drugs.

 

Note: The drug lists may change year-round.

What’s in the formulary?

  • Covered drugs
  • Copayment details, including tiers
  • When prior authorization is required
  • Limits on refills, doses or prescriptions
  • Using generic substitutions, therapeutic interchange or step-therapy protocols
  • How formulary updates are communicated, how often, and if scheduled updates apply

 

Cropped shot of a pharmacist filling a prescription at a chemist

What if your drug is not covered?

Call your doctor’s office and ask for help. Your doctor may:

  • Change your drug to one that is covered.
  • Decide that your drug is “medically necessary” and fill out a Prior Authorization (PA) form.
  • If a PA is needed, your doctor will send the proper forms to your pharmacy.

IEHP DualChoice members:

View the IEHP DualChoice formulary

 

For questions, call IEHP DualChoice Member Services at 1-877-273-IEHP (4347). TTY users should call 1-800-718-4347.

IEHP Covered members:

View the IEHP Covered formulary


For questions, call IEHP Covered Member Services at 1-855-433-IEHP (4347). TTY users should call 711.

IEHP Medi-Cal members:

Refer to Medi-Cal Rx Contract Drug list. To find out if a drug is on the Medi-Cal Rx Contract Drug List or to get a copy of it: Call Medi-Cal Rx at 1-800-977-2273. Press 7 for TTY. Visit Medi-Cal Rx.