Formulary (Drug List)
A comprehensive Formulary is an entire list of covered drugs. The Saint Alphonsus Health Plan Formulary offers a wide selection of brand and generic medications.
Use our Find and Price a Drug tool to see if your drugs are covered and estimate drug prices.
Get a List of Covered Drugs
For a full list of all drugs covered by your plan, you can download a PDF copy of the full formulary below.
2024 Formulary (last updated 12/01/2024)
2025 Formulary (last updated 10/15/2024)
If you would like a Formulary mailed to you, you can request one by contacting Member Services.
Notice of Formulary Updates
Saint Alphonsus Health Plan may add or remove drugs from our Formulary during the year. If we remove drugs from our Formulary, add prior authorization requirements, quantity limits and/or step therapy restrictions on a drug, or move a drug to a higher cost-sharing tier, we must notify members who take the drug at least 60 days before the date on which the change becomes effective, or at the time the member requests a refill of the drug. If the Food and Drug Administration deems a drug on the Formulary to be unsafe, or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our Formulary and provide notice to members who are taking the drug. If a drug you are currently taking is being removed from the Formulary, please check with your doctor to see if you can transition to a comparable drug.
Click to view and/or download the 2024 Negative Formulary Changes (last updated 12/01/2024)
Real-Time Benefits
Members can access real-time Formulary and benefit information by using the Check Drug Cost tool on the CVS Caremark website. Comparing real-time benefits will allow you to see cost-sharing information as well as help you find lower-cost alternative therapies that may be available. To access the Check Drug Cost tool, log into or create your account at CVS Caremark.
To access the Check Drug Cost tool, log into or create your account at CVS Caremark. If you have an account on the Saint Alphonsus Health Plan Member Portal, you can click the Caremark link in the Drug Benefits section of the portal to access Caremark via single sign-on.
Formulary Exceptions
You can request a coverage determination (also known as a Formulary exception) if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. You can also ask for an exception to utilization management restrictions, such as a limit on the quantity of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision.
To request a formulary exception, please call 1-866-785-5714 (TTY 711), 24 hours a day, 7 days a week, or complete this form on the CVS Caremark website.
This page was last updated 12/01/2024