What Is A Prescription Drug Formulary?
Alliance CompleteCare uses a formulary. A formulary is a list of drugs covered by your plan to meet patient needs. We may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members’ ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you or click here to see our complete formulary on our Web site.

Alliance CompleteCare covers 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.

Prior Authorization (PA) Requirements
If you are currently taking a drug that requires a Prior Authorization (PA), you may choose to submit a Coverage Determination Request by sending us a completed Coverage Determination Request Form. Click here for the Coverage Determination Request Form (for Member use). If someone is submitting the Coverage Determination Form on your behalf, they must also submit the Appointment of Representative Form. Click here for the Appointment of Representative Form. Both forms must be complete and require the beneficiary’s signature.

For a complete list of Prior Authorization (PA) Guidelines, click here. You may also be eligible to receive your medication under our transition policy. Click here to see our transition policy.

Limits and Exception Requests
If you are currently taking a drug that is not on our formulary, or is subject to step therapy or quantity limits, you can contact us to initiate an Exception Request or you may switch to an alternative drug listed on our formulary with your physician’s help. Click here to see the Step Therapy Criteria.

An Exception Request requires a physician's supporting statement (PSS). A PSS must be submitted for the request process to begin. A PSS is a medical justification to support the need for the requested medication and is written by your physician. You may also be eligible to receive your medication under our transition policy. Click here to see our transition policy.

Step Therapy
In some cases, Alliance CompleteCare requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Alliance CompleteCare may not cover drug B unless you try Drug A first. If Drug A does not work for you, Alliance CompleteCare will then cover Drug B. Click here to see our Step Therapy Criteria.

If you have questions related to the Medicare Part D Prescription Drug program, call us toll-free at 1-877-585-PLAN (7526), (TTY) 1-888-747-1574, seven days a week, 8 a.m. to 8 p.m.

Here are three simple ways to help you determine whether a specific prescription drug is covered by your Alliance CompleteCare health plan. Please select from the options below.

Option 1: Search By Name

Name of Drug

Acidifying Agents Adrenals Alkalinizing Agents Alpha-Adrenergic Blocking Agents Ammonia Detoxicants Analgesics and Antipyretics -- Non-Steroidal Anti-inflammatory Agents -- Opiate Agonists -- Opiate Partial Agonists Androgens Anorexigenics, Respiratory, Cerebral Stimulants -- Amphetamines -- Anorexigenics, Respiratory, Cerebral Stimulants, Miscellaneous Anthelmintics Anti-infectives (EENT) -- Antibacterials (EENT) -- Antifungals (EENT) -- Antivirals (EENT) -- EENT Anti-infectives, Miscellaneous Anti-infectives (Skin and Mucous Membrane) -- Antibacterials (Skin and Mucous Membrane) -- Antifungals (Skin and Mucous Membrane) -- Antivirals (Skin and Mucous Membrane) -- Local Anti-infectives, Miscellaneous -- Scabicides and Pediculicides Anti-infectives (systemic), Misc. Anti-inflammatory Agents (EENT) -- Corticosteroids (EENT) -- EENT Anti-inflammatory Agents, Miscellaneous -- EENT Non-Steroidal Anti-inflammatory Agents Anti-inflammatory Agents (GI Drugs) Anti-inflammatory Agents (Respiratory) -- Leukotriene Modifiers -- Mast Cell Stablilizers Anti-inflammatory Agents (Skin and Mucous) Antiallergic Agents Antibacterials -- Aminoglycosides -- Antibacterials, Miscellaneous -- Cephalosporins -- Chloramphenicol -- Macrolides -- Miscellaneous B-Lactam Antibiotics -- Penicillins -- Quinolones -- Sulfonamides (Systemic) -- Tetracyclines Anticholinergic Agents -- Antimuscarinics/Antispasmodics Anticonvulsants -- Anticonvulsants, Miscellaneous -- Barbiturates (Anticonvulsants) -- Hydantoins -- Succinimides Antidiabetic Agents -- Alpha-Glucosidase Inhibitors -- Amylinomimetics -- Biguanides -- Dipeptidyl Peptidase-4 (dpp-4) Inhibitors -- Incretin Mimetics -- Insulins -- Meglitinides -- Sulfonylureas -- Thiazolidinediones Antidiarrhea Agents Antiemetics -- 5-HT3 Receptor Antagonists -- Antiemetics, Miscellaneous -- Antihistamines (GI Drugs) Antifungals (Systemic) -- Allylamines -- Antifungals, Miscellaneous -- Azoles -- Echinocandins -- Polyenes -- Pyrimidines Antiglaucoma Agents -- Alpha-Adrenergic Agonists (EENT) -- Beta-Adrenergic Blocking Agents (EENT) -- Carbonic Anhydrase Inhibitors (EENT) -- Miotics -- Prostaglandin Analogs Antihemorrhagic Agents -- Hemostatics Antihypoglycemic Agents -- Glycogenolytic Agents Antilipemic Agents -- Antilipemic Agents, Miscellaneous -- Bile Acid Sequestrants -- Cholesterol Absorption Inhibitors -- Fibric Acid Derivatives -- HMG-CoA Reductase Inhibitors Antimanic Agents Antimigraine Agents -- Selective Serotonin Agonists Antimycobacterials -- Antimycobacterials, Miscellaneous -- Antituberculosis Agents Antineoplastic Agents Antiparkinsonian Agents -- Adamantanes (CNS) -- Anticholinergic Agents (CNS) -- Catechol-O-Methyltransferase (COMT) Inhibitors -- Dopamine Precursors -- Dopamine Receptor Agonists -- Monoamine Oxidase B Inhibitors Antiprotozoals -- Amebicides -- Antimalarials -- Antiprotozoals, Miscellaneous Antipruritics and Local Anesthetics Antithrombotic Agents -- Anticoagulants -- Platelet Aggregation Inhibitors -- Platelet-reducing Agents Antiulcer Agents and Acid Suppressants -- Histamine H2-Antagonists -- Prostaglandins -- Protectants -- Proton Pump Inhibitors Antivirals (Systemic) -- Adamantanes -- Antiretrovirals -- Antivirals, Miscellaneous -- Interferons -- Monoclonal Antibodies -- Neuraminidase Inhibitors -- Nucleosides and Nucleotides Anxiolytics, Sedatives and Hypnotics -- Anxiolytics, Sedatives and Hypnotics, Miscellaneous Astringents Autonomic Drugs, Miscellaneous Beta-Adrenergic Blocking Agents Calcium Channel Blocking Agents -- Calcium Channel Blocking Agents, Miscellaneous -- Dihydropyridines Caloric Agents Cardiac Drugs -- Antiarrhythmic Agents -- Cardiac Drugs, Miscellaneous -- Cardiotonic Agents Cathartics and Laxatives Cell Stimulants and Proliferants Central Nervous System Agents, Miscellaneous Cholelitholytic Agents Contraceptives Depigmenting and Pigmenting Agents -- Depigmenting Agents -- Pigmenting Agents Devices Digestants Diuretics -- Diuretics, Miscellaneous -- Loop Diuretics -- Potassium-Sparing Diuretics -- Thiazide Diuretics -- Thiazide-Like Diuretics EENT Drugs, Miscellaneous Emollients, Demulcents, and Protectants -- Basic Lotions and Liniments -- Basic Ointments and Protectants Enzymes Estrogens and Antiestrogens -- Estrogen Agonist-Antagonists -- Estrogens First Generation Antihistamines -- Ethanolamine Derivatives -- First Generation Antihistamine Derivatives, Miscellaneous -- Phenothiazine Derivatives -- Propylamine Derivatives Genitourinary Smooth Muscle Relaxants GI Drugs, Miscellaneous Gold Compounds Gonadotropins Heavy Metal Antagonists Hematopoietic Agents Hemorrheologic Agents Hypotensive Agents -- Central Alpha-Agonists -- Direct Vasodilators -- Peripheral Adrenergic Inhibitors Ion-Removing Agents -- Other Ion-removing Agents -- Phosphate-Removing Agents -- Potassium-Removing Agents Irrigating Solutions Keratolytic Agents Keratoplastic Agents Local Anesthetics (EENT) Local Anesthetics (Parenteral) Miscellaneous Therapeutic Agents Mucolytic Agents Multivitamin Preparations Mydriatics Opiate Antagonists Oxytocics Parasympathomimetics (Cholinergic Agents) Parathyroid Pharmaceutical Aids Pituitary Progestins Prokinetic Agents Psychotherapeutic Agents -- Antidepressants -- Antipsychotic Agents Renin-Angiotensin-Aldosterone System Inhibitors -- Angiotensin II Receptor Antagonists -- Angiotensin-Converting Enzyme Inhibitors -- Mineralocorticoid (Aldosterone) Antagonists -- Renin Inhibitors Replacement Preparations Respiratory Smooth Muscle Relaxants Respiratory Tract Agents, Miscellaneous Second Generation Antihistamines Serums Skeletal Muscle Relaxants -- Centrally-Acting Skeletal Muscle Relaxants -- Direct-Acting Skeletal Muscle Relaxants -- Gaba-Derivative Skeletal Muscle Relaxants Skin and Mucous Membrane Agents, Miscellaneous Somatotropin Agonists and Antagonists -- Somatotropin Agonists -- Somatotropin Antagonists Sympatholytic Adrenergic Blocking Agents Sympathomimetic (Adrenergic) Agents -- Alpha- and Beta-Adrenergic Agonists -- Alpha-Adrenergic Agonists -- Beta-Adrenergic Agonists Thyroid and Antithyroid Agents -- Antithyroid Agents -- Thyroid Agents Toxoids Uricosuric Agents Urinary Anti-infectives Vaccines Vasoconstrictors Vasodilating Agents -- Nitrates and Nitrites -- Phosphodiesterase Inhibitors -- Vasodilating Agents, Miscellaneous Vitamin D

Drug Class

Option 2: Search Alphabetically

Simply click on the letter below to find a complete listing of all medications in the Alliance CompleteCare Drug Formulary beginning with that letter.

ABCDEFGHIJKLMNOPQRSTUVWXYZ

OPTION 3: SEARCH THE PRINTABLE FORMULARY

*If your drug is in Tier 1, only the generic drug is covered.
If your drug is in Tier 2, the brand-name drug is covered.

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.


Click here for more information on these topics:

• Definitions
• Our Formulary and Formulary Update Policy
• Tier Structure
• Tips for Reducing Out-of-Pocket Drug Costs
• Prescription Drug Programs
• Out of Network Coverage
• Part D Member Rights and Responsibilities
• Quality Assurance and Medication Therapy Management programs
• Our Pharmacy Transition Policy and Process

Formulary, drug search, and utilization management information last updated July 2010.

Best Available Evidence Policy