Drug Name Search
Enter a drug name to begin
Disclaimer:

Inclusion of a drug on the formulary does not guarantee coverage under your plan. Please check your specific Certificate of Coverage for applicable benefits and exclusions or contact our Customer Service at 1-800-897-1923 to verify benefits as necessary.

By Alphabet
Select a letter to view drugs starting with that letter
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
By Therapeutic Class
Please select a therapy class to continue
Legend
T1
Preferred Generics
T2
Non-Preferred Generics and Preferred Brands
T3
Non-Preferred Brands
T4
Specialty
T5
$0 Cost Share
T6
Medical Service Drugs
NF
Non-Formulary
QL
Quantity Limit
PA
Prior Authorization
ST
Step Therapy
AL1
Age Limit
Preferred Drug
Specialty Non-Preferred Formulary Brand
BRAND NAMES
generic names
2017 GUNDERSEN HEALTH PLAN DRUG FORMULARY
Welcome
We cover both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. Visit www.GundersenHealthPlan.org for additional information and resources.
What is a Formulary?
A formulary is a list of covered drugs which represents the prescription therapies believed to be a necessary part of a quality treatment program. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Printable Files
The following files require Adobe Acrobat, click here to download it now
Printable Formulary
Prior Authorization
Step Therapy
Quantity Limit
2017 Maintenance Medication List.
Our plan uses a national drug database to define a list of drugs that are considered maintenance medications. This list is subject to change at any time due to the dynamic changes occurring within the pharmacy industry, such as additions and removals of drugs from the market.
Comprehensive Prior Authorization Criteria Document
Prior Authorization Form
How to Search For Drugs
  • Use the alphabetical list to search by the first letter of your medication.
  • Search by typing part of the generic (chemical) and brand (trade) names.
  • Search by selecting the therapeutic class of the medication you are looking for.
  • How to Request an Exception
    You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make:
  • You can ask us to cover your drug even if it is not on our formulary.
  • You can ask us to waive coverage restrictions or limits on your drug.
  • You can ask us to provide a higher level of coverage for your drug.

  • If you need to request a formulary, tiering or utilization restriction exception you will need to submit a statement from your physician supporting along with a completed prior authorization form (link in printable documents above). Once the physician’s supporting statement is received, we will make our decision within 72 hours. You may request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If you meet criteria for an urgent request, we render a decision no later than 24 hours after we receive the physician’s supporting statement.