FORMULARY (PREFERRED DRUG LIST)

The formulary (preferred drug list) of covered retail and specialty pharmacy medications and any prescribing limits, such as quantity limits, step therapy, and/or prior authorization requirements, is available on our website.

• Health Choice Utah Pharmacy Formulary

FORMULARY CHANGES

Our medication and pharmacy information is updated as changes occur. Please visit our pharmacy website at least quarterly to view the most recent formulary change notice information.

• Health Choice Utah may add or remove drugs from the formulary throughout the year.
• If a drug you currently prescribe is scheduled to be removed from the formulary, we will notify you and the affected member at least 60 days before the change takes effect.
• If the U.S. Food and Drug Administration (FDA) deems a drug unsafe, or the drug's manufacturer pulls it from the market, we will remove it from the formulary immediately and notify you and the member afterward.

PRIOR AUTHORIZATION

Pharmacy prior authorization (PA) policies are available on our website. Visit our Coverage Policies site to ensure you are submitting the correct form for the requested medication. We recommend bookmarking these links for quick access when submitting pharmacy PA requests.

• Drug/Disease-Specific Medication Forms
• General Pharmacy PA Form

To submit through the RealRx PA portal, visit nexusgate-pbmui.cbgapps.io/public and click "Get Started" under "Request Prior Authorization."

FORMULARY EXCEPTION

The pharmacy formulary exception (FE) policy is available on our Coverage Policies site. Formulary exception requests will only be accepted by submitting a formulary exception request form.

To submit through the RealRx PA portal, visit nexusgate-pbmui.cbgapps.io/public and click "Formulary Exception" under "Plan Forms."