2011 Formulary
A current list of covered drugs representing the prescription therapies believed to be a necessary part of a quality program. The Formulary may change throughout the year as we add new less expensive generic drugs, remove drugs that are determined to be unsafe or ineffective, or add prior authorization, quantity limits and/or step therapy restrictions on a drug.

 2011 Formulary PA Criteria

 2011 Formulary ST Criteria

  2012 Formulary H5209-002_H7475-001_CWHPFC07-14-11A CMS Approved 09/06/2011
A current list of covered drugs representing the prescription therapies believed to be a necessary part of a quality program. The Formulary may change throughout the year as we add new less expensive generic drugs, remove drugs that are determined to be unsafe or ineffective, or add prior authorization, quantity limits and/or step therapy restrictions on a drug.

  2012 Formulary Medicaid Supplement_H5209-002_H7475-001_CWHPFMS07-14-11A CMS Approved 08/02/2011

 2012 Formulary PA Criteria

 2012 Formulary ST Criteria

 Part D Formulary Transition Policy and Procedure

Medicare Part D Low-Income Subsidy (LIS) Premium Assistance

Prescription Drug Grievance, Appeal, Coverage Determination and Exception Processes

H5209-002_H7475-001_CWHPWEB_12-21-11A CMS Approved 12/29/2011
Last Updated 12/21/2011 DHS Approved 12/22/2011