My Online Services
The best way to view your formulary, as well as other important plan documents, is to log in to the secure member portal, My Online Services. Your experience is personalized to you! Login or register today.
ATTENTION INDIVIDUAL MEMBERS: some plans have different formulary information. Did you get covered through healthcare.gov or CoventryOne.com? Individual members (covered through healthcare.gov or CoventryOne.com) should go to CoventryOne.com for formulary information, as well as other important coverage details.
Please do not use these formularies when checking your medication needs. Please refer to chcillinoismedicare.com for the correct formulary. You can also call the Member Services Department at 800-533-0367, Monday through Friday from 8:00 a.m. to 8:00 p.m. for any prescription questions. If you are hearing impaired, please call our TDD line at 877-231-0573.
Group Online Searchable Formulary
The information below for the Commercial Formulary and the Commercial Formulary for Small Groups is appropriate for members covered through an employer group, but is not appropriate for all Coventry business. To learn which formulary is available to you, call the Customer Service number on your Member ID card for assistance.
COMMERCIAL FORMULARY FOR SMALL GROUPS:
- 2017 Commercial Formulary for Small Group Search - Select 5-Tier Open
- 2016 Commercial Formulary for Small Group Search – Five Tier Select
Within the group formulary, you may search for drugs using several different methods.
- First, searches can be conducted by simply clicking on the appropriate first letter of the drug name under the Alphabetical Search section.
- Secondly, you may search by drug name using the Brand & Generic Name Search option where products are listed by both brand (trade) and generic (chemical) names. Click in the entry box, type the first few letters (e.g. “Zoc”) or all of the drug name (e.g. “Zocor”), and click the Go button.
- Or lastly, click on the appropriate drug class (e.g. “Anti-infective Agents”) under the Therapeutic Class Search section.
Group Formulary Documents
The documents below for the Commercial Formulary and the Commercial Formulary for Small Groups is appropriate for members covered through an employer group, but is not appropriate for all Coventry business. To learn which formulary is available to you, call the Customer Service number on your Member ID card for assistance.
- Self-Administered Injectables Formulary List
- Quantity Limit List
- Prior Authorization Criteria (ZIP)
- Prior Authorization Forms (ZIP)
COMMERCIAL FORMULARY FOR SMALL GROUPS:
Formularies have several purposes. One is to ensure that the drugs offered are of the highest quality and efficacy. Another purpose is to reduce prescription drug costs, which are rising at an alarming rate. Monitoring prescription costs and maintaining a formulary helps us keep premiums down while offering a high level of benefits. In addition, our doctors and pharmacists stay current on the newest nationwide developments in medicine. We continually update our formulary based on the latest research.
For some members, nonformulary medicines also are covered under their pharmacy benefit at the highest copay. Most of the time, doctors will prescribe a medicine from the formulary. If a doctor prescribes a medication that is not on the list, members may get that medication, but will share in a greater portion of the cost. We encourage our members to ask their doctors if a medication is on the formulary and, if not, whether there is a formulary drug that will work as well.
Express Scripts Mail Order
Not all employer groups offer prescription benefits as part of health care coverage. Please check with your employer to verify whether you have prescription benefit coverage and at what level. In order to use the Express Scripts Mail Order Form, your employer must offer you the option to receive select prescription drugs by mail.
If you order prescriptions through mail order, the Express Scripts customer service department will be able to assist you in tracking your prescription. You may contact Express Scripts at 800-735-4404 or visit their website at www.express-scripts.com.
Coventry Health Care members may purchase a 90-day supply of maintenance medications at one time. A maintenance medication is one that is used to treat a chronic condition. Some examples of chronic conditions would be high blood pressure, diabetes, or hypothyroidism.
90-Day Pharmacy Network
For more details about 90-day prescription benefits, please call the number on the back of your member ID card.