Request a formulary  
 Complete the form below to have a 2020 paper formulary mailed to you. Please expect 10 business days to arrive.  


Consider the following when making the formulary selection:

  • 2020 Prescription Drug Formulary: All plans except Extra + Rx
    Formulary for the following plans: Bridge 1 + Rx (HMO), Bridge 2 + Rx (HMO), Choice + Rx 001 (HMO-POS), Choice + Rx 002 (HMO-POS), Compass + Rx (HMO-POS), Cottonwood + Rx (HMO), Enrich + Rx (HMO), Harbor + Rx (HMO), Latitude + Rx (HMO-POS), Pine + Rx (HMO), Prime + Rx (HMO), Summit + Rx (HMO-POS) and Timber + Rx (HMO)
  • 2020 Prescription Drug Formulary: Extra plans only
    Formulary for Extra + Rx (HMO) and Extra Part B Only + Rx (HMO) plans
  • 2020 Prescription Drug Formulary: Dual Plus plan
    Formulary for our Dual Plus (HMO D-SNP) plan
  • 2020 Prescription Drug Formulary: Group plans
    Formulary for Align + Rx 10/50/1000 (HMO), Align + Rx 15/30 (HMO) and Flex + Rx 10/50/1000 (HMO-POS) group plans

The formulary may change at any time. You will receive notice when necessary.

Please include street address, city, state and ZIP code.