What drugs are covered?
Each plan has a formulary, which is a CMS approved list of medications covered by Alterwood Advantage. The formulary drugs covered are similar from plan to plan, but your out-of-pocket copay or coinsurance for a prescription will vary.
All formularies offer you and your doctor a variety of choices to treat your condition. You may view or download a copy of the formularies we offer by selecting the links below. In addition, you may search for your drug(s).
Some drugs on our formularies are subject to a coverage determination (also known as prior authorization), step-therapy, and or quantity limits. These are utilization management tools we use to ensure appropriate and medically necessary use of these drugs. More information about these utilization management tools can be found here.
When transitioning into our plan, you may be on drug(s) that are not on the Alterwood Advantage formulary. We have made arrangements with the network pharmacies to provide you a transition supply that will allow you to contact your prescriber(s) to transitioning you to similar drug(s) on our formulary that treats your condition(s). More information regarding our Transition Policy can be found here.