Member Secured Services

Custom Formulary

The Custom Formulary is used with triple-tier copayment or closed (managed) formulary plans only. If you're not sure whether your plan uses the Custom Formulary, check your prescription drug benefit packet or contact customer service.

• Download the Custom Formulary Quick Guide for Members (PDF) - Shows the formulary status of most commonly used drugs
• Download the complete Custom Formulary (PDF)
• Download the most recent formulary updates (PDF)
• Specialty drugs are identified in the Quick Guide and through Member Secured Services. A full list of specialty drugs and information about this program can be found on the Specialty drugs page.
• Log in to Member Secured Services to find your copayment on prescription drugs, including those not listed on the Custom Formulary Quick Guide.

Use our Custom Formulary Lookup Tool to see the current tier of any drug in our Custom Formulary.

Drugs in our Custom Formularies are categorized as follows:

Tier 1 — Generic

These drugs have a proven record of safety and effectiveness and offer the best value. Tier 1 drugs require the lowest copayment, making them your most cost-effective option for treatment. All generic drugs are Formulary Preferred.

Tier 2 — Formulary (Preferred) Brand

These brand-name drugs also have a record of safety and effectiveness. Because more cost-effective therapy or a generic alternative is usually available, drugs in Tier 2 require a higher copayment.

Tier 3 — Nonformulary (Nonpreferred) Brand

Nonformulary brand-name drugs are not included in our Custom Formulary. Tier 3 drugs may not have a proven record for safety or their clinical value may not be as high as the drugs in Tier 1 or Tier 2. Formulary alternatives are available. Depending on your plan's drug rider, you may pay a higher copayment for Tier 3 drugs than for those in Tier 1 or Tier 2, or even be responsible for the entire cost.