Prescription Drugs
Formularies
Learn about the generic and brand-name drugs covered by Jefferson Health Plans.
Formulary
Our online lists of drugs that are covered by Jefferson Health Plans, also known as formularies, can be searched by drug name or category or can be downloaded as a PDF.
Additional Resources
Drug Recalls
The U.S. Food and Drug Administration keeps an updated list of drug recalls. Any members affected will receive a drug recall letter from Jefferson Health Plans in the mail.
Prior Authorization and Formulary Exceptions
Sometimes, your doctor would like you to have a drug that is not listed in our formulary. In these instances, the non-formulary medication may be requested through a prior authorization, formulary exception or reimbursement.
About Step Therapy
Step Therapy is a type of coverage determination that applies to certain drugs. When Step Therapy applies, we require you to try certain drugs to treat your medical condition first before we will cover another drug for that condition.
Here's How it Works:
- For example, if Drug A and Drug B both treat your medical condition, Jefferson Health Plans may not cover Drug B unless you try Drug A first. If Drug A does not work for you, Jefferson Health Plans will then cover Drug B.
Drugs subject to Step Therapy are marked with an “ST” code in our print and online formularies, which you can view here.
Contact Us
We are here to help answer your questions about formularies. If you're a member and haven’t found what you’re looking for on this page, please call our friendly Member Relations team at 1-833-422-4690 (TTY 1-877-454-8477).
Commonly Asked Questions
What is a formulary?
A formulary is a list of covered drugs selected by Jefferson Health Plans in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Jefferson Health Plans will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Jefferson Health Plans network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
Can the formulary change?
Yes, our formulary, or drug list, can change. Most changes in drug coverage happen on January 1, but Jefferson Health Plans may add or remove drugs on the formulary during the year, move them to different cost-sharing tiers, or add new restrictions.
How do I use the formulary?
The formulary is your way of knowing what drugs are covered under your health plan. There are three ways to search for your drug within the formulary:
- Alphabetically, by using the first letter of your medication
- By name, using either the brand name or generic name of your medication
- By selecting the therapeutic class of the medication you are looking for
What are generic drugs?
A generic drug is approved by the FDA as having the same active ingredient as the brand-name drug. Generally, generic drugs cost less than brand-name drugs. Jefferson Health Plans covers both brand-name drugs and generic drugs.