Request a formulary  
 Complete the form below to have a 2025 paper formulary mailed to you. Please expect 10 business days to arrive.  

 
 

Consider the following when making the formulary selection:

  • 2025 Prescription Drug Formulary: All Individual plans except Choice + Rx, Dual Plus + Rx, and Sycamore + Rx
    Formulary for the following plans: Bridge + Rx (HMO-POS), Cottonwood + Rx (HMO-POS), Extra + Rx (HMO), Pine + Rx (HMO), Prime + Rx (HMO), and Timber + Rx (HMO).
  • 2025 Prescription Drug Formulary: Choice + Rx
    Formulary for Choice + Rx (HMO-POS)
  • 2025 Prescription Drug Formulary: Sycamore + Rx
    Formulary for Sycamore + Rx (HMO)
  • 2025 Prescription Drug Formulary: Dual Plus plan
    Formulary for our Dual Plus (HMO D-SNP) plan
  • 2025 Prescription Drug Formulary: Align Group plan
    Formulary for Align + Rx 10/50/1000 (HMO), Align + Rx 15/30 (HMO)

  • 2025 Prescription Drug Formulary: Discover Group plan and Explore Group plan
    Formulary for Align-Discover + Rx (HMO), 804 Align-Explore + Rx (HMO), and 805 Discover + Rx (HMO-POS), 805 Explore + Rx (HMO-POS)

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

   
 
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