The formulary and utilization management (UM) program listings found here are representative of the standard offerings with ProAct. The appearance of a product on one or more of these listings does not guarantee coverage. Due to the dynamics of the prescription drug industry, these listings should only be used as a guide as new products may become available at any time*.
The Core and Advantage formularies are the basis of preferred and non-preferred products used in conjunction with a member’s prescription drug plan. Medications are broken down into generic and brand name products. In most cases, brand products not appearing on the formulary list indicate the product is non-preferred, or even excluded. For the Advantage formulary, there are certain medications that are excluded from coverage. The Advantage Formulary Exclusions companion document lists the excluded medication(s), along with suggested alternative(s).
Utilization management (UM) program listings represent the standard UM offerings for prior authorization (PA), quantity limits (QL), and step therapy (ST). There may be other medications subject to one or more of these edits based on a member’s specific plan design, or due to a change in the prescription drug market.
*Standard offering does not consider plan design or other client-specific parameters which may affect the drug and/or UM listings. Members wishing to explore specific and detailed information surrounding coverage of products on their prescription drug plan should access our member portal, or contact the ProAct Help Desk at 1-877-635-9545.