Access Formulary Drug List
EFFECTIVE: JULY 1, 2025
About this drug list
This is a list of the medications included in your prescription plan. It is not, however, a complete list of products that are on the formulary, nor does it guarantee coverage. Please ask your prescriber to consider preferred medications from this list when medically appropriate.
How to read this drug list
Use the chart below to help you read this drug list. This chart is just an example. It may not show how these medications are actually covered on the 2025 Access Formulary List. Medications are listed by the condition they treat, then listed alphabetically.
The formulary is the list of drugs included in your prescription plan. Ask your prescriber to consider PREFERRED medications from this list when medically appropriate. Inclusion on the list does not guarantee coverage. The following list is not a complete list of products that are on the formulary.
Newly FDA approved medications are subject to evaluation by the Plan for coverage status and formulary placement prior to inclusion in the Prescription Drug Benefit including the Specialty Drug Benefit.
Abbreviations next to medications
In this drug list, formulary status (i.e., generic, preferred, or non-preferred) and extra coverage requirements (i.e., prior authorization) are indicated to the right of the medication. Here’s what they mean:
(G)
(P)
(NP)
Generic medications are denoted by (G). The most affordable medications.
Preferred Medication
Preferred medications are denoted by (P). Ask your doctor about choosing a preferred medication.
Non-Preferred Medication
Non-preferred medications are denoted by (NP). The more expensive medications.
(SP)
(PA)
Specialty Medication
Some medications are considered specialty medications. These medications are denoted by (SP) and are available through our specialty pharmacy network.
Prior Authorization
Certain medications require VerusRx’s approval before they are covered by your plan. These medications are denoted by (PA). Unless your doctor requests and receives approval from VerusRx, your plan will not cover these medications.
Abbreviations next to medications
Medications are organized into groups in the table below. First, identify the appropriate group for your medication, then navigate to that section to view the covered medications. If you cannot find your medication within a group, please use the search feature or contact our customer service team for assistance.
This list contains injectable medical drugs covered under medical policies. For specific questions about your coverage, please call the phone number printed on your member ID card.
For the Health Care Provider: Please prescribe PREFERRED products and allow generic substitutions when medically appropriate.
ADHD/ANTINARCOLEPSY/ANTIOBESITY/ ANOREXIANTS
| MEDICATION NAME | FORMULARY STATUS | SPECIALTY STATUS | PA STATUS |
|---|---|---|---|
| ADDERALL | NON PREFERRED | ||
| ADDERALL XR | NON PREFERRED | P1P1 | |
| AMPHETAMINE SULFATE | GENERIC | ||
| AMPHETAMINE/DEXTROAMPHETA MINE | GENERIC | ||
| AMPHETAMINE/DEXTROAMPHETA MINE ER | GENERIC | ||
| APTENSIO XR | NON PREFERRED | ||
| ARMODAFINIL | GENERIC | ||
| ATOMOXETINE | GENERIC | ||
| ATOMOXETINE HYDROCHLORIDE | GENERIC | ||
| AZSTARYS | PREFERRED | PA | |
| CAFFEINE ANHYDROUS | NON PREFERRED | ||
| CAFFEINE CITRATE | GENERIC | ||
| CAFFEINE CITRATE | NON PREFERRED | ||
| CAFFEINE CITRATED | NON PREFERRED | ||
| CAFFEINE/SODIUM BENZOATE | GENERIC | ||
| CLONIDINE HCL ER | GENERIC | ||
| CLONIDINE HYDROCHLORIDE E R | GENERIC | ||
| CONCERTA | NON PREFERRED | ||
| DAYTRANA | NON PREFERRED | PA | |
| DEXMETHYLPHENIDATE HCL | GENERIC | ||
| DEXMETHYLPHENIDATE HYDROC HLORIDE | GENERIC | ||
| DEXMETHYLPHENIDATE HCL ER | GENERIC | ||
| DEXMETHYLPHENIDATE HYDROC HLORIDE ER | GENERIC | ||
| DEXTROAMPHETAMINE SULFATE ER | GENERIC | ||
| DEXTROAMPHETAMINE SULFATE | GENERIC | ||
| DOPRAM | NON PREFERRED | ||
| DYANAVEL XR | NON PREFERRED | ||
| EVEKEO | NON PREFERRED | ||
| FOCALIN | NON PREFERRED | ||
| FOCALIN XR | NON PREFERRED | ||
| GUANFACINE HYDROCHLORIDE ER | GENERIC | ||
| INTUNIV | NON PREFERRED | ||
| JORNAY PM | NON PREFERRED | ||
| LISDEXAMFETAMINE DIMESYLA TE | GENERIC | ||
| METADATE CD | NON PREFERRED | ||
| METHAMPHETAMINE HYDROCHLO RIDE | GENERIC | ||
| METHYLIN | NON PREFERRED | ||
| METHYLPHENIDATE | GENERIC | PA | |
| METHYLPHENIDATE HYDROCHLO RIDE | GENERIC | ||
| METHYLPHENIDATE HYDROCHLO RIDE ER | GENERIC | ||
| METHYLPHENIDATE HYDROCHLO RIDE ER (LA) | GENERIC | ||
| METHYLPHENIDATE HYDROCHLO RIDE CD | GENERIC | ||
| MODAFINIL | GENERIC | ||
| NUVIGIL | NON PREFERRED | ||
| ONYDA XR | NON PREFERRED | ||
| PROCENTRA | GENERIC | ||
| PROVIGIL | NON PREFERRED | ||
| QELBREE | PREFERRED | PA | |
| QUILLICHEW ER | NON PREFERRED | ||
| QUILLIVANT XR | NON PREFERRED | ||
| RELEXXII | NON PREFERRED | ||
| RITALIN | NON PREFERRED | ||
| RITALIN LA | NON PREFERRED | ||
| STRATTERA | NON PREFERRED | ||
| VYVANSE | NON PREFERRED | ||
| WAKIX | PREFERRED | SP | PA |
| XELSTRYM | NON PREFERRED | PA | |
| ZENZEDI | GENERIC | ||
| ZENZEDI | NON PREFERRED |
AMEBICIDES
| MEDICATION NAME | FORMULARY STATUS | SPECIALTY STATUS | PA STATUS |
|---|---|---|---|
| IODOQUINOL | NON PREFERRED |
AMINOGLYCOSIDES
| MEDICATION NAME | FORMULARY STATUS | SPECIALTY STATUS | PA STATUS |
|---|---|---|---|
| AMIKACIN SULFATE | GENERIC | ||
| AMIKACIN SULFATE | NON PREFERRED | ||
| ARIKAYCE | NON PREFERRED | SP | PA |
| BETHKIS | NON PREFERRED | SP | PA |
| GENTAMICIN SULFATE | GENERIC | ||
| GENTAMICIN SULFATE PEDIAT RIC | GENERIC | ||
| GENTAMICIN SULFATE/0.9% S ODIUM CHLORIDE | GENERIC | ||
| HUMATIN | NON PREFERRED | ||
| ISOTONIC GENTAMICIN | GENERIC | ||
| KITABIS PAK | PREFERRED | SP | PA |
| NEOMYCIN SULFATE | GENERIC | ||
| STREPTOMYCIN SULFATE | GENERIC | ||
| STREPTOMYCIN SULFATE | NON PREFERRED | ||
| TOBI | NON PREFERRED | SP | PA |
| TOBI PODHALER | PREFERRED | SP | PA |
| TOBRAMYCIN | GENERIC | SP | PA |
| TOBRAMYCIN SULFATE | GENERIC | ||
| TOBRAMYCIN SULFATE | NON PREFERRED | ||
| ZEMDRI | NON PREFERRED |
ANALGESICS - ANTI-INFLAMMATORY
| MEDICATION NAME | FORMULARY STATUS | SPECIALTY STATUS | PA STATUS |
|---|---|---|---|
| ABRILADA 1-PEN KIT | NON PREFERRED | SP | PA |
| ABRILADA 2-PEN KIT | NON PREFERRED | SP | PA |
| ABRILADA | NON PREFERRED | SP | PA |
| ACTEMRA | NON PREFERRED | SP | PA |
| ACTEMRA ACTPEN | NON PREFERRED | SP | PA |
| ADALIMUMAB-AACF STARTER P ACK/PSORIASIS/UVEITIS (4 PEN) | NON PREFERRED | SP | PA |
| ADALIMUMAB-AACF STARTER P ACK/CD/UC/HS (6 PEN) | NON PREFERRED | SP | PA |
| ADALIMUMAB-AACF (2 PEN) | NON PREFERRED | SP | PA |
| ADALIMUMAB-AACF (2 SYRING E) | NON PREFERRED | SP | PA |
| ADALIMUMAB-AATY 1-PEN KIT | NON PREFERRED | SP | PA |
| ADALIMUMAB-AATY 2-PEN KIT | NON PREFERRED | SP | PA |
| ADALIMUMAB-AATY 2-SYRINGE KIT | NON PREFERRED | SP | PA |
| ADALIMUMAB-AATY CD/UC/HS STARTER | NON PREFERRED | SP | PA |
| ADALIMUMAB-ADAZ | PREFERRED | SP | PA |
| ADALIMUMAB-ADBM | NON PREFERRED | SP | PA |
| ADALIMUMAB-ADBM STARTER P ACKAGE FOR CROHNS DISEASE/UC/HS | NON PREFERRED | SP | PA |
| ADALIMUMAB-ADBM STARTER P ACKAGE FOR PSORIASIS/UVEITIS | NON PREFERRED | SP | PA |
| ADALIMUMAB-ADBM PSORIASIS /UVEITIS STARTER | NON PREFERRED | SP | PA |
| ADALIMUMAB-ADBM CROHNS/UC /HS STARTER | NON PREFERRED | SP | PA |
| ADALIMUMAB-FKJP | PREFERRED | SP | PA |
| ADALIMUMAB-RYVK (2 PEN) | NON PREFERRED | SP | PA |
| ADALIMUMAB-RYVK | NON PREFERRED | SP | PA |
| AMJEVITA | NON PREFERRED | SP | PA |
| ANAPROX DS | NON PREFERRED | ||
| ARAVA | NON PREFERRED | ||
| ARCALYST | NON PREFERRED | SP | PA |
| ARTHROTEC 50 | NON PREFERRED | ||
| ARTHROTEC 75 | NON PREFERRED | ||
| AURANOFIN | NON PREFERRED | ||
| CALDOLOR | NON PREFERRED | ||
| CELEBREX | NON PREFERRED | ||
| CELECOXIB | GENERIC | ||
| COMBOGESIC | NON PREFERRED | ||
| COXANTO | NON PREFERRED | ||
| CYLTEZO | NON PREFERRED | SP | PA |
| CYLTEZO STARTER PACKAGE F OR CROHNS DISEASE/UC/HS | NON PREFERRED | SP | PA |
| CYLTEZO STARTER PACKAGE F OR PSORIASIS | NON PREFERRED | SP | PA |
| CYLTEZO STARTER PACKAGE F OR PSORIASIS/UVEITIS | NON PREFERRED | SP | PA |
| DAYPRO | NON PREFERRED | ||
| DICLOFENAC POTASSIUM | GENERIC | ||
| DICLOFENAC SODIUM DR | GENERIC | ||
| DICLOFENAC SODIUM ER | GENERIC | ||
| DICLOFENAC SODIUM/MISOPRO STOL | GENERIC | ||
| EC-NAPROSYN | NON PREFERRED | ||
| EC-NAPROXEN | GENERIC | ||
| ENBREL | PREFERRED | SP | PA |
| ENBREL MINI | PREFERRED | SP | PA |
| ENBREL SURECLICK | PREFERRED | SP | PA |
| ETODOLAC | GENERIC | ||
| ETODOLAC ER | GENERIC | ||
| FENOPROFEN CALCIUM | GENERIC | ||
| FENOPROFEN CALCIUM | NON PREFERRED | ||
| FENOPRON | NON PREFERRED | ||
| FLURBIPROFEN | NON PREFERRED | ||
| FLURBIPROFEN | GENERIC | ||
| HADLIMA | PREFERRED | SP | PA |
| HADLIMA PUSHTOUCH | PREFERRED | SP | PA |
| HULIO | NON PREFERRED | SP | PA |
| HUMIRA | PREFERRED | SP | PA |
| HUMIRA PEN | PREFERRED | SP | PA |
| HUMIRA PEN-CD/UC/HS START ER | PREFERRED | SP | PA |
| HUMIRA PEN-PS/UV STARTER | PREFERRED | SP | PA |
| HYRIMOZ | PREFERRED | SP | PA |
| HYRIMOZ SENSOREADY PENS | PREFERRED | SP | PA |
| HYRIMOZ CROHN'S DISEASE A ND ULCERATIVE COLITIS STARTER PACK | PREFERRED | SP | PA |
| HYRIMOZ PEDIATRIC CROHNS DISEASE STARTER PACK | PREFERRED | SP | PA |
| HYRIMOZ PEDIATRIC CROHN'S DISEASE STARTER PACK | PREFERRED | SP | PA |
| HYRIMOZ PLAQUE PSORIASIS/ UVEITIS STARTER PACK | PREFERRED | SP | PA |
| HYRIMOZ PLAQUE PSORIASIS STARTER PACK | PREFERRED | SP | PA |
| IBU | GENERIC | ||
| IBUPROFEN | GENERIC | ||
| IBUPROFEN LYSINE | GENERIC | ||
| ILARIS | PREFERRED | SP | PA |
| INDOCIN | NON PREFERRED | PA | |
| INDOCIN | NON PREFERRED | ||
| INDOMETHACIN | GENERIC | ||
| INDOMETHACIN | NON PREFERRED | ||
| INDOMETHACIN | GENERIC | PA | |
| INDOMETHACIN | NON PREFERRED | PA | |
| INDOMETHACIN ER | GENERIC | ||
| KETOROCAINE-L | NON PREFERRED | ||
| KETOROLAC TROMETHAMINE | GENERIC | ||
| KETOROLAC TROMETHAMINE | NON PREFERRED | ||
| KETOROLAC TROMETHAMINE/BU PIVACAINE HYDROCHLORIDE/KETAMINE HY | NON PREFERRED | ||
| KETAMINE HYDROCHLORIDE/RO PIVACAINE HYDROCHLORIDE/KETOROLAC T | NON PREFERRED | ||
| KEVZARA | PREFERRED | SP | PA |
| KINERET | NON PREFERRED | SP | PA |
| LEFLUNOMIDE | GENERIC | ||
| LODINE | NON PREFERRED | ||
| LURBIPR | NON PREFERRED | ||
| MECLOFENAMATE SODIUM | GENERIC | ||
| MEFENAMIC ACID | NON PREFERRED | ||
| MELOXICAM | GENERIC | ||
| MELOXICAM | NON PREFERRED | ||
| NABUMETONE | GENERIC | ||
| NALFON | NON PREFERRED | ||
| NAPROSYN | NON PREFERRED | ||
| NAPROXEN | GENERIC | ||
| NAPROXEN | NON PREFERRED | ||
| NAPROXEN DR | GENERIC | ||
| NAPROXEN SODIUM | NON PREFERRED | ||
| NAPROXEN SODIUM | GENERIC | ||
| NEOPROFEN | NON PREFERRED | ||
| OLUMIANT | NON PREFERRED | SP | PA |
| ORENCIA CLICKJECT | NON PREFERRED | SP | PA |
| ORENCIA | NON PREFERRED | SP | PA |
| OTEZLA | PREFERRED | SP | PA |
| OXAPROZIN | GENERIC | ||
| PHENYLBUTAZONE | NON PREFERRED | ||
| PIROXICAM | GENERIC | ||
| PIROXICAM | NON PREFERRED | ||
| RIDAURA | NON PREFERRED | ||
| RINVOQ LQ | PREFERRED | SP | PA |
| RINVOQ | PREFERRED | SP | PA |
| SIMLANDI 1-PEN KIT | NON PREFERRED | SP | PA |
| SIMLANDI 2-PEN KIT | NON PREFERRED | SP | PA |
| SIMLANDI | NON PREFERRED | SP | PA |
| SIMPONI | PREFERRED | SP | PA |
| SIMPONI ARIA | PREFERRED | SP | PA |
| SULINDAC | NON PREFERRED | ||
| SULINDAC | GENERIC | ||
| TOFIDENCE | NON PREFERRED | SP | PA |
| TOLECTIN 600 | NON PREFERRED | ||
| TOLMETIN SODIUM | GENERIC | ||
| TRESNI | NON PREFERRED | ||
| TYENNE | NON PREFERRED | SP | PA |
| XELJANZ | PREFERRED | SP | PA |
| XELJANZ XR | PREFERRED | SP | PA |
| YUFLYMA 1-PEN KIT | NON PREFERRED | SP | PA |
| YUFLYMA 2-PEN KIT | NON PREFERRED | SP | PA |
| YUFLYMA 2-SYRINGE KIT | NON PREFERRED | SP | PA |
| YUFLYMA CD/UC/HS STARTER | NON PREFERRED | SP | PA |
| YUSIMRY | NON PREFERRED | SP | PA |